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General NPI Number Information
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NPI Number | 1710236336
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Entity Type | Individual
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Provider Name | THOMAS MEREDITH BOOTH LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/29/2012
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Last Update Date | 09/21/2018
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Provider Practice Location Address
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Address Line | 20151 NORDHOFF ST
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City | CHATSWORTH
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State | CA
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Zip | 91311-6215
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Country | US
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Telephone | 213-804-7660
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Fax |
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Provider Business Mailing Address
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Address Line | 4869 TOPANGA CANYON BLVD STE 1
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City | WOODLAND HILLS
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State | CA
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Zip | 91364-4253
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Country | US
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Telephone | 818-437-8453
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 74254
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 36467
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License Number State | CA
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