Provider Demographics
NPI:1851781942
Name:MARCOTTE, THOMAS DAVID (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:DAVID
Last Name:MARCOTTE
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:PO BOX 19088
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92159-0088
Mailing Address - Country:US
Mailing Address - Phone:619-543-5044
Mailing Address - Fax:
Practice Address - Street 1:220 DICKINSON ST
Practice Address - Street 2:SUITE B
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-2071
Practice Address - Country:US
Practice Address - Phone:619-543-5044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15428103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist