MEDICARE: MR. ANDREW EDWARD MOLDENHAUER LMSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	34011272A	IN
2	1041C0700X	Clinical Social Worker	6801095699	MI
3	104100000X	Social Worker	6801095699	MI

General Provider Information

NPI Number	:	1881026284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANDREW EDWARD MOLDENHAUER LMSW

Provider Business Mailing Address
First Line	:	10179 POKAGON LOOP
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46818-0191
Country	:	US
Telephone Number	:	248-633-8606
Fax Number	:

Provider Business Practice Location Address
First Line	:	36400 WOODWARD AVE STE 202
Second Line	:
City	:	BLOOMFIELD HILLS
State	:	MI
Zip	:	48304-0913
Country	:	US
Telephone Number	:	248-633-8606
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/07/2013
Last Update Date	:	01/12/2025

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