Provider Demographics
NPI:1710119011
Name:PARKER, ANDREW L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:L
Last Name:PARKER
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 1:625 LARKSPUR PLAZA DR
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1452
Mailing Address - Country:US
Mailing Address - Phone:415-717-0921
Mailing Address - Fax:
Practice Address - Street 1:3 MADRONA ST
Practice Address - Street 2:#3A
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-1845
Practice Address - Country:US
Practice Address - Phone:415-717-0921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-20
Last Update Date:2009-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18301103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical