Provider Demographics
NPI:1902505043
Name:ANDUJAR, PHILIP PAUL (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:PHILIP
Middle Name:PAUL
Last Name:ANDUJAR
Suffix:
Gender:M
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 FRONT ST STE 211
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-1244
Mailing Address - Country:US
Mailing Address - Phone:907-364-4565
Mailing Address - Fax:
Practice Address - Street 1:225 FRONT ST STE 211
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-1244
Practice Address - Country:US
Practice Address - Phone:907-364-4565
Practice Address - Fax:907-364-4469
Is Sole Proprietor?:No
Enumeration Date:2023-02-27
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06917900104100000X
AK215403104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker