Provider Demographics
NPI:1003260738
Name:TOMOYASU, NAOMI (PHD)
Entity Type:Individual
Prefix:DR
First Name:NAOMI
Middle Name:
Last Name:TOMOYASU
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10269 BRISTOL CHANNEL
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-5820
Mailing Address - Country:US
Mailing Address - Phone:410-971-1102
Mailing Address - Fax:410-203-2258
Practice Address - Street 1:10269 BRISTOL CHANNEL
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-5820
Practice Address - Country:US
Practice Address - Phone:410-971-1102
Practice Address - Fax:410-203-2258
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-19
Last Update Date:2016-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012109-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical