Provider Demographics
NPI:1295142289
Name:ANDREW CLARK DEAN
Entity type:Organization
Organization Name:ANDREW CLARK DEAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:CLARK
Authorized Official - Last Name:DEAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:310-892-3235
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:310-892-3235
Mailing Address - Fax:310-872-1588
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:310-892-3235
Practice Address - Fax:310-872-1588
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DEAN NEUROPSYCHOLOGY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-07-22
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY21280103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB223024Medicare UPIN