Provider Demographics
NPI:1275500860
Name:TILLOTSON, TOM STUART (LCSW)
Entity Type:Individual
Prefix:MR
First Name:TOM
Middle Name:STUART
Last Name:TILLOTSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4444 PARK BLVD
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94602-1340
Mailing Address - Country:US
Mailing Address - Phone:510-530-5360
Mailing Address - Fax:925-370-4827
Practice Address - Street 1:150 MUIR RD
Practice Address - Street 2:VETERANS AFFAIRS NORTHERN CALIFORNIA HEALTHCARE S102
Practice Address - City:MARTINEZ
Practice Address - State:CA
Practice Address - Zip Code:94553-4668
Practice Address - Country:US
Practice Address - Phone:925-370-4726
Practice Address - Fax:925-370-4827
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS20110104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker