Provider Demographics
NPI:1598980765
Name:TRABIN, TOM (PHF)
Entity Type:Individual
Prefix:DR
First Name:TOM
Middle Name:
Last Name:TRABIN
Suffix:
Gender:M
Credentials:PHF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5820 BARRETT AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-1411
Mailing Address - Country:US
Mailing Address - Phone:510-236-6868
Mailing Address - Fax:
Practice Address - Street 1:5820 BARRETT AVE
Practice Address - Street 2:
Practice Address - City:EL CERRITO
Practice Address - State:CA
Practice Address - Zip Code:94530-1411
Practice Address - Country:US
Practice Address - Phone:510-236-6868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11886103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY11886OtherCALIF LIC