Healthcare Provider Details

I. General information

NPI: 1558069864
Provider Name (Legal Business Name): FATHOM PSYCHOLOGY, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2023
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2590 E MAIN ST STE 201
VENTURA CA
93003-2619
US

IV. Provider business mailing address

2590 E MAIN ST STE 201
VENTURA CA
93003-2619
US

V. Phone/Fax

Practice location:
  • Phone: 805-628-2546
  • Fax:
Mailing address:
  • Phone: 805-628-2546
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SUSAN D SHARMA
Title or Position: PRESIDENT
Credential: PSYD
Phone: 805-628-2546