Provider Demographics
NPI:1689979270
Name:GADOMSKI, TONYA MARIE (BA, MFTI)
Entity Type:Individual
Prefix:MISS
First Name:TONYA
Middle Name:MARIE
Last Name:GADOMSKI
Suffix:
Gender:F
Credentials:BA, MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:516 W 10TH ST
Mailing Address - Street 2:
Mailing Address - City:ANTIOCH
Mailing Address - State:CA
Mailing Address - Zip Code:94509-1654
Mailing Address - Country:US
Mailing Address - Phone:925-778-3800
Mailing Address - Fax:
Practice Address - Street 1:516 W 10TH ST
Practice Address - Street 2:
Practice Address - City:ANTIOCH
Practice Address - State:CA
Practice Address - Zip Code:94509-1654
Practice Address - Country:US
Practice Address - Phone:925-778-3800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-01-13
Last Update Date:2012-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 70644106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist