Peabody, Tom
Peabody, Tom is an sole proprietor health care provider with primary practice located at 345 Lorton Ave Suite 104, Burlingame CA 94010-4133. He recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Clinical, Behavioral Health & Social Service Providers / Psychologist. Behavioral Health & Social Service Providers / Clinical is his primary health care specialty. Peabody, Tom can be contacted via phone (650) 634-9807.Contact Information
Primary practice address
345 Lorton Ave Suite 104
Burlingame CA 94010-4133
Phone: (650) 634-9807
Fax: (650) 348-3087
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Clinical | 103TC0700X | PSY15343 | California |
| Behavioral Health & Social Service Providers / Psychologist | 103T00000X | PSY15343 | California |
Profile Details
| NPI number | 1144306218 |
|---|---|
| LBN Legal business name | Peabody, Tom |
| Credentials | PH.D. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Oct 31st, 2006 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1144306218 | NPPES |
| California | MEDICAID | PSY153430 |
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