MEDICARE: DR. THOMAS JOHN DAKOSKE PSYCHOLOGIST

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	103T00000X	Psychologist	7454	CA

General Provider Information

NPI Number	:	1922188101
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS JOHN DAKOSKE PSYCHOLOGIST

Provider Business Mailing Address
First Line	:	1171 CARDIFF CIR
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91362-2004
Country	:	US
Telephone Number	:	805-807-0110
Fax Number	:	805-497-7700

Provider Business Practice Location Address
First Line	:	4055 E THOUSAND OAKS BLVD
Second Line	:	SUITE 215
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-3600
Country	:	US
Telephone Number	:	805-379-2223
Fax Number	:	805-379-2223

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

Provider Enumeration Date	:	10/16/2006
Last Update Date	:	07/08/2007

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