Provider Demographics
NPI:1790961860
Name:THOMAS, ROSA L (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSA
Middle Name:L
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ROSA
Other - Middle Name:L
Other - Last Name:THOMAS LAWRENCE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:369B 3RD ST # 117
Mailing Address - Street 2:
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3581
Mailing Address - Country:US
Mailing Address - Phone:707-548-4968
Mailing Address - Fax:
Practice Address - Street 1:870 MARKET ST STE 453
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-3011
Practice Address - Country:US
Practice Address - Phone:707-548-4968
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-18
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20906103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CQ133AMedicare PIN