| Doctor Name: | ANDREW MOULDOVAN |
| NPI Number: | 1033415625 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MSW |
| License Number: | |
| Business Practice Address: | 8002 Kew Gardens Rd Kew Gardens, NY - 114153600 |
| Business Phone Number: | 7185201513 |
| Business Fax Number: | 7185206460 |
| Mailing Address: | Po Box 31094, HARTFORD |
| State: | CT |
| Postal Code: | 061501094 |
| Phone Number: | 5189528140 |
| Fax Number: | 5189528287 |
| NPI Enumeration Date: | 01/31/2011 |
| NPI Last Update Date: | 01/31/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |