Provider Demographics
NPI:1649260670
Name:GALVIN, THOMAS P
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:P
Last Name:GALVIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1302 D ST
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-4204
Mailing Address - Country:US
Mailing Address - Phone:567-202-0690
Mailing Address - Fax:567-349-4402
Practice Address - Street 1:1302 D ST
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-4204
Practice Address - Country:US
Practice Address - Phone:567-202-0690
Practice Address - Fax:567-349-4402
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00088221041C0700X
CALCSW742091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCSW74209OtherLCSW