Healthcare Provider Details

I. General information

NPI: 1619227006
Provider Name (Legal Business Name): THOMAS MARCHEVSKY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/13/2012
Last Update Date: 03/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5332 COLLEGE AVE STE. 100
OAKLAND CA
94618-2805
US

IV. Provider business mailing address

5332 COLLEGE AVE STE 100
OAKLAND CA
94618-2805
US

V. Phone/Fax

Practice location:
  • Phone: 415-413-0631
  • Fax:
Mailing address:
  • Phone: 415-413-0631
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY26278
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY26278
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License NumberPSY26278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: