Provider Demographics
NPI:1033146592
Name:BLEW, ANDREW F (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:F
Last Name:BLEW
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:955 DEEP VALLEY DRIVE #3346
Mailing Address - Street 2:
Mailing Address - City:PALOS VERDES PENINSULA
Mailing Address - State:CA
Mailing Address - Zip Code:90274-3087
Mailing Address - Country:US
Mailing Address - Phone:310-937-0600
Mailing Address - Fax:310-406-2939
Practice Address - Street 1:877 N DOUGLAS ST
Practice Address - Street 2:
Practice Address - City:EL SEGUNDO
Practice Address - State:CA
Practice Address - Zip Code:90245-2801
Practice Address - Country:US
Practice Address - Phone:310-937-0600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-28
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8152103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical