Andrea Lynn Andrzejczak, PH.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

6301009783 Issued in MI

Practice address

17850 Maumee Ave
Suite 4
Grosse Pointe, MI 48230-1612

Phone

(313) 885-8350

Fax

(313) 885-8357

NPI assigned

Dec 4, 2006

Last updated

Aug 31, 2016By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in MI

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1995

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Andrea Andrzejczak PH.D.

  • Point of Service
  • Grosse Pointe Woods, MI
  • NPI 1841436201
  NPD (past) Authorized official
• Downriver Mental Health Clinic PC

  dba Lifestance Health, Inc

  • Psychologist
  • Taylor, MI
  • NPI 1295866135
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1165190400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1472601600000",
    "number": "1568520559",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "20867 MACK AVE",
            "address_2": "SUITE 4",
            "city": "GROSSE POINTE WOODS",
            "state": "MI",
            "postal_code": "482361392",
            "telephone_number": "313-885-8350",
            "fax_number": "313-885-8357"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17850 MAUMEE AVE",
            "address_2": "SUITE 4",
            "city": "GROSSE POINTE",
            "state": "MI",
            "postal_code": "482301612",
            "telephone_number": "313-885-8350",
            "fax_number": "313-885-8357"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ANDRZEJCZAK",
        "first_name": "ANDREA",
        "middle_name": "LYNN",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-12-04",
        "last_updated": "2016-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MI",
            "license": "6301009783",
            "primary": true
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MI",
            "license": "6301009783",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Psychologist in Grosse Pointe, MI
• Providers in Grosse Pointe, MI by specialty
• Psychologist in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.