Healthcare Provider Details

I. General information

NPI: 1164108924
Provider Name (Legal Business Name): ZOE THORNE
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1339 20TH STREET
SANTA MONICA CA
90404
US

IV. Provider business mailing address

5550 GROSVENOR BLVD APT 113
LOS ANGELES CA
90066
US

V. Phone/Fax

Practice location:
  • Phone: 310-829-8708
  • Fax:
Mailing address:
  • Phone: 248-935-4357
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: