Provider Demographics
NPI:1073655064
Name:DEAN, ANDREW C (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:C
Last Name:DEAN
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 1:1654 S ORANGE DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-5314
Mailing Address - Country:US
Mailing Address - Phone:310-825-5839
Mailing Address - Fax:310-825-0812
Practice Address - Street 1:1654 S ORANGE DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90019-5314
Practice Address - Country:US
Practice Address - Phone:310-825-5839
Practice Address - Fax:310-825-0812
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21280103TC0700X, 103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGA145ZMedicare PIN
CACB2203025Medicare UPIN