Provider Demographics
NPI:1871661488
Name:ONORATO, THOMAS DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DAVID
Last Name:ONORATO
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 1:4560 ADMIRALTY WAY
Mailing Address - Street 2:STE. 353
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5423
Mailing Address - Country:US
Mailing Address - Phone:310-338-9002
Mailing Address - Fax:310-642-0856
Practice Address - Street 1:4560 ADMIRALTY WAY
Practice Address - Street 2:STE. 353
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5423
Practice Address - Country:US
Practice Address - Phone:310-338-9002
Practice Address - Fax:310-642-0856
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-01
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11518103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY115180Medicaid
CAR15621Medicare UPIN
CACP11518Medicare ID - Type UnspecifiedPROVIDER NUMBER
CAPSY115180Medicaid