Provider Demographics
NPI:1528389251
Name:CARR, ANDREW (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:CARR
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:PO BOX 7063
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89510-7063
Mailing Address - Country:US
Mailing Address - Phone:626-325-8091
Mailing Address - Fax:
Practice Address - Street 1:427 S MARENGO AVE STE 6
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-3134
Practice Address - Country:US
Practice Address - Phone:626-325-8091
Practice Address - Fax:626-325-8091
Is Sole Proprietor?:No
Enumeration Date:2010-06-16
Last Update Date:2020-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X, 103TH0004X
CA28126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth