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General NPI Number Information
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NPI Number | 1639383516
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Entity Type | Individual
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Provider Name | MARY ANDRES PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/09/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3470 TROUSDALE PKWY WPH 1001 A
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City | LOS ANGELES
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State | CA
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Zip | 90089-4036
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Country | US
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Telephone | 213-740-8521
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Fax |
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Provider Business Mailing Address
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Address Line | 225 4TH AVE #103
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City | VENICE
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State | CA
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Zip | 90291-8605
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Country | US
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Telephone | 310-621-0325
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Fax | 213-740-2367
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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