Provider Demographics
NPI:1881026284
Name:MOLDENHAUER, ANDREW EDWARD (LMSW)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:EDWARD
Last Name:MOLDENHAUER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10179 POKAGON LOOP
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46818-0191
Mailing Address - Country:US
Mailing Address - Phone:248-633-8606
Mailing Address - Fax:
Practice Address - Street 1:36400 WOODWARD AVE STE 202
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-0913
Practice Address - Country:US
Practice Address - Phone:248-633-8606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-07
Last Update Date:2025-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34011272A104100000X
MI68010956991041C0700X, 104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical