Provider Demographics
NPI:1639383516
Name:ANDRES, MARY (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:ANDRES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 4TH AVE
Mailing Address - Street 2:#103
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-8605
Mailing Address - Country:US
Mailing Address - Phone:310-621-0325
Mailing Address - Fax:213-740-2367
Practice Address - Street 1:3470 TROUSDALE PKWY
Practice Address - Street 2:WPH 1001 A
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90089-4036
Practice Address - Country:US
Practice Address - Phone:213-740-8521
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist