Provider Demographics
NPI:1811872757
Name:GRAHAM, ANDREW (PSYD)
Entity type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:
Last Name:GRAHAM
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 AVIATION BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90278-4059
Mailing Address - Country:US
Mailing Address - Phone:310-376-2468
Mailing Address - Fax:
Practice Address - Street 1:1200 AVIATION BLVD STE 100
Practice Address - Street 2:
Practice Address - City:REDONDO BEACH
Practice Address - State:CA
Practice Address - Zip Code:90278-4059
Practice Address - Country:US
Practice Address - Phone:310-376-2468
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-08
Last Update Date:2025-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94028431103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist