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General NPI Number Information
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NPI Number | 1194845198
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Entity Type | Individual
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Provider Name | THOMAS DEANTONIO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 03/31/2007
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Last Update Date | 11/02/2022
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Provider Practice Location Address
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Address Line | 1361 BLUFF DR
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City | HAILEY
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State | ID
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Zip | 83333-8895
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Country | US
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Telephone | 818-399-7384
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Fax |
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Provider Business Mailing Address
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Address Line | 820 S MAIN ST UNIT 3671
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City | HAILEY
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State | ID
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Zip | 83333-6339
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Country | US
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Telephone | 818-399-7384
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PSY14726
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License Number State | CA
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