Provider Demographics
NPI:1053779280
Name:MINARD, ANDREW RONALD (LISW-S)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:RONALD
Last Name:MINARD
Suffix:
Gender:M
Credentials:LISW-S
Other - Prefix:MR
Other - First Name:ANDY
Other - Middle Name:
Other - Last Name:MINARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LISW-S
Mailing Address - Street 1:37 E WILSON BRIDGE RD STE 280
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-1106
Mailing Address - Country:US
Mailing Address - Phone:614-607-1125
Mailing Address - Fax:614-515-4525
Practice Address - Street 1:37 E WILSON BRIDGE RD STE 280
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-1106
Practice Address - Country:US
Practice Address - Phone:604-607-1125
Practice Address - Fax:614-515-4525
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.0900177.SUPV1041C0700X
OHI.09001771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0188157Medicaid