Provider Demographics
NPI:1679669386
Name:O'SHEA, THOMAS RAYMOND (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:RAYMOND
Last Name:O'SHEA
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:407 REQUEZA ST
Mailing Address - Street 2:#E-6
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-3767
Mailing Address - Country:US
Mailing Address - Phone:760-942-2486
Mailing Address - Fax:
Practice Address - Street 1:741 GARDEN VIEW CT
Practice Address - Street 2:SUITE 105
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2470
Practice Address - Country:US
Practice Address - Phone:760-944-4181
Practice Address - Fax:760-944-4181
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8302103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPX0083020Medicaid
CA00CP83020Medicare ID - Type Unspecified
CACP8302Medicare ID - Type Unspecified
CAPX0083020Medicaid