Healthcare Provider Details

I. General information

NPI: 1013435585
Provider Name (Legal Business Name): MARGET C THOMAS PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2017
Last Update Date: 09/05/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4201 LONG BEACH BLVD
LONG BEACH CA
90807-2007
US

IV. Provider business mailing address

2512 N POINSETTIA AVE
MANHATTAN BEACH CA
90266-2666
US

V. Phone/Fax

Practice location:
  • Phone: 800-624-1475
  • Fax:
Mailing address:
  • Phone: 860-857-6079
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: