Healthcare Provider Details

I. General information

NPI: 1407995335
Provider Name (Legal Business Name): DOUGLAS CRAIG THOMAS LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 04/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

95 N MARENGO AVE SUITE 200
PASADENA CA
91101-1764
US

IV. Provider business mailing address

95 N MARENGO AVE SUITE 200
PASADENA CA
91101-1764
US

V. Phone/Fax

Practice location:
  • Phone: 626-524-2406
  • Fax:
Mailing address:
  • Phone: 626-524-2406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number18683
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: