MEDICARE: DR. TERESA ELLEN THOMAS PH.D.

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	103G00000X	Clinical Neuropsychologist	PSY 16869	CA

General Provider Information

NPI Number	:	1952325169
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TERESA ELLEN THOMAS PH.D.

Provider Business Mailing Address
First Line	:	1516 OAK ST
Second Line	:	STE. 313
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2947
Country	:	US
Telephone Number	:	510-340-9196
Fax Number	:	510-340-9197

Provider Business Practice Location Address
First Line	:	1516 OAK ST
Second Line	:	STE. 313
City	:	ALAMEDA
State	:	CA
Zip	:	94501-2947
Country	:	US
Telephone Number	:	510-340-9196
Fax Number	:	510-340-9197

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

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	01/03/2022

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