Provider Demographics
NPI:1801535943
Name:MUNOZ, ANDREW ERIC (MSW)
Entity type:Individual
Prefix:
First Name:ANDREW
Middle Name:ERIC
Last Name:MUNOZ
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1230 E PRIVET DR UNIT 4-427
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84121-7621
Mailing Address - Country:US
Mailing Address - Phone:018-251-6077
Mailing Address - Fax:
Practice Address - Street 1:59 W 9000 S
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84070-2008
Practice Address - Country:US
Practice Address - Phone:801-251-6077
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-05-27
Last Update Date:2024-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WASX613338411041C0700X
UT11266039-35011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1801535943Medicaid