Healthcare Provider Details

I. General information

NPI: 1528389251
Provider Name (Legal Business Name): ANDREW CARR PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/16/2010
Last Update Date: 06/01/2020
Certification Date: 06/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 S MARENGO AVE STE 6
PASADENA CA
91101-3134
US

IV. Provider business mailing address

PO BOX 7063
RENO NV
89510-7063
US

V. Phone/Fax

Practice location:
  • Phone: 626-325-8091
  • Fax: 626-325-8091
Mailing address:
  • Phone: 626-325-8091
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number28126
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: