Provider Demographics
NPI:1689761447
Name:MARCIC, THOMAS JOHN (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOHN
Last Name:MARCIC
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 1:17337 KENNEDY DR
Mailing Address - Street 2:
Mailing Address - City:NORTH REDINGTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33708-1350
Mailing Address - Country:US
Mailing Address - Phone:727-409-4045
Mailing Address - Fax:352-596-4581
Practice Address - Street 1:17337 KENNEDY DR
Practice Address - Street 2:
Practice Address - City:NORTH REDINGTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33708-1350
Practice Address - Country:US
Practice Address - Phone:727-409-4045
Practice Address - Fax:352-596-4581
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY003378103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical