Healthcare Provider Details

I. General information

NPI: 1164355897
Provider Name (Legal Business Name): ANDREW DANIEL LUDWICK
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/03/2026
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 E GISH RD
SAN JOSE CA
95112-4706
US

IV. Provider business mailing address

232 E GISH RD
SAN JOSE CA
95112-4706
US

V. Phone/Fax

Practice location:
  • Phone: 408-876-4284
  • Fax: 866-377-6462
Mailing address:
  • Phone: 408-876-4284
  • Fax: 866-377-6462

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberAMFT16072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: