Provider Demographics
NPI:1114937778
Name:OLDENBURGER, THOMAS (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:
Last Name:OLDENBURGER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3171 LOS FELIZ BLVD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90039-1527
Mailing Address - Country:US
Mailing Address - Phone:323-326-3761
Mailing Address - Fax:323-660-2116
Practice Address - Street 1:3171 LOS FELIZ BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90039-1527
Practice Address - Country:US
Practice Address - Phone:323-326-3761
Practice Address - Fax:323-660-2116
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS231521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical