Healthcare Provider Details

I. General information

NPI: 1992919153
Provider Name (Legal Business Name): THOMAS F MERRIFIELD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2340 WARD ST #201
BERKELEY CA
94705-1124
US

IV. Provider business mailing address

419 COVENTRY RD
KENSINGTON CA
94707-1314
US

V. Phone/Fax

Practice location:
  • Phone: 510-684-7192
  • Fax: 510-527-8548
Mailing address:
  • Phone: 510-527-8548
  • Fax: 510-527-8548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number7122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: