Healthcare Provider Details

I. General information

NPI: 1821019357
Provider Name (Legal Business Name): THOMAS J. MRAZ PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20800 WESTGATE MALL SUITE 103
FAIRVIEW PARK OH
44126-1323
US

IV. Provider business mailing address

PO BOX 45075
WESTLAKE OH
44145-0075
US

V. Phone/Fax

Practice location:
  • Phone: 831-901-7790
  • Fax:
Mailing address:
  • Phone: 831-917-7900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number7441
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: