Provider Demographics
NPI:1558069864
Name:FATHOM PSYCHOLOGY, PC
Entity Type:Organization
Organization Name:FATHOM PSYCHOLOGY, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHARMA
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:805-628-2546
Mailing Address - Street 1:260 MAPLE CT STE 223
Mailing Address - Street 2:
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-3567
Mailing Address - Country:US
Mailing Address - Phone:805-628-2546
Mailing Address - Fax:
Practice Address - Street 1:260 MAPLE CT STE 223
Practice Address - Street 2:
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-3567
Practice Address - Country:US
Practice Address - Phone:805-628-2546
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-16
Last Update Date:2023-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty