Provider Demographics
NPI:1417935776
Name:LAYTE, THOMAS M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:LAYTE
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 1:3094 W RAMSEY ST
Mailing Address - Street 2:
Mailing Address - City:BANNING
Mailing Address - State:CA
Mailing Address - Zip Code:92220-3724
Mailing Address - Country:US
Mailing Address - Phone:951-849-0145
Mailing Address - Fax:951-849-9207
Practice Address - Street 1:3094 W RAMSEY ST
Practice Address - Street 2:
Practice Address - City:BANNING
Practice Address - State:CA
Practice Address - Zip Code:92220-3724
Practice Address - Country:US
Practice Address - Phone:951-849-0145
Practice Address - Fax:951-849-9207
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS166111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACSW166110Medicaid
CAZZZ00333ZMedicare PIN