MEDICARE: MR. THOMAS JOSEPH DUNLEAVY LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	83293	CA
2	101YM0800X	Mental Health Counselor	LCSW103340	CA
3	1041C0700X	Clinical Social Worker	103340	CA
4	390200000X	Student in an Organized Health Care Education/Training Program
5	1041C0700X	Clinical Social Worker	LCSW103340	CA

General Provider Information

NPI Number	:	1689198764
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. THOMAS JOSEPH DUNLEAVY LCSW

Provider Business Mailing Address
First Line	:	5665 WILSHIRE BLVD STE 1206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3710
Country	:	US
Telephone Number	:	213-583-2170
Fax Number	:

Provider Business Practice Location Address
First Line	:	5665 WILSHIRE BLVD STE 1206
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90036-3710
Country	:	US
Telephone Number	:	213-583-2170
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2017
Last Update Date	:	04/19/2023

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