Provider Demographics
NPI:1639378144
Name:LAM, THOMAS T (MSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:T
Last Name:LAM
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:TUNG
Other - Middle Name:
Other - Last Name:LAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:PO BOX 3231
Mailing Address - Street 2:
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92038-3231
Mailing Address - Country:US
Mailing Address - Phone:760-300-9923
Mailing Address - Fax:
Practice Address - Street 1:9444 BALBOA AVE STE 200
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4374
Practice Address - Country:US
Practice Address - Phone:858-514-3117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-13
Last Update Date:2021-12-21
Deactivation Date:2021-12-13
Deactivation Code:
Reactivation Date:2021-12-20
Provider Licenses
StateLicense IDTaxonomies
MI6801097431104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker