Provider Demographics
NPI:1659258622
Name:BANDURSKI, ANDREW JAMES
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:JAMES
Last Name:BANDURSKI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 HUNTERS LN
Mailing Address - Street 2:
Mailing Address - City:PLANTSVILLE
Mailing Address - State:CT
Mailing Address - Zip Code:06479-1578
Mailing Address - Country:US
Mailing Address - Phone:203-651-9260
Mailing Address - Fax:
Practice Address - Street 1:20 WOODSIDE AVE
Practice Address - Street 2:
Practice Address - City:MIDDLEBURY
Practice Address - State:CT
Practice Address - Zip Code:06762-2857
Practice Address - Country:US
Practice Address - Phone:203-941-8680
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-20
Last Update Date:2025-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT153941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical