MEDICARE: DR. TOM GORDON BEKENY PH.D.

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	103TC0700X	Clinical Psychologist	PSY 14304	CA

General Provider Information

NPI Number	:	1124110523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TOM GORDON BEKENY PH.D.

Provider Business Mailing Address
First Line	:	2481 CLAY ST
Second Line	:	SUITE 203
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1808
Country	:	US
Telephone Number	:	415-567-6581
Fax Number	:	415-474-6409

Provider Business Practice Location Address
First Line	:	2481 CLAY ST
Second Line	:	SUITE 203
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94115-1808
Country	:	US
Telephone Number	:	415-567-6581
Fax Number	:	415-474-6409

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

Provider Enumeration Date	:	09/29/2006
Last Update Date	:	04/18/2008

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