MEDICARE: MR. THOMAS OLDENBURGER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS23152	CA

General Provider Information

NPI Number	:	1114937778
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS OLDENBURGER LCSW

Provider Business Mailing Address
First Line	:	3171 LOS FELIZ BLVD
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1527
Country	:	US
Telephone Number	:	323-326-3761
Fax Number	:	323-660-2116

Provider Business Practice Location Address
First Line	:	3171 LOS FELIZ BLVD
Second Line	:	SUITE 200
City	:	LOS ANGELES
State	:	CA
Zip	:	90039-1527
Country	:	US
Telephone Number	:	323-326-3761
Fax Number	:	323-660-2116

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/08/2006
Last Update Date	:	07/08/2007

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