Provider Demographics
NPI:1912128570
Name:THOMSEN, EDITH (PHD)
Entity Type:Individual
Prefix:DR
First Name:EDITH
Middle Name:
Last Name:THOMSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:EDE
Other - Middle Name:
Other - Last Name:THOMSEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:401 43RD AVE
Mailing Address - Street 2:# 204
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94121-1562
Mailing Address - Country:US
Mailing Address - Phone:415-336-1176
Mailing Address - Fax:415-751-3310
Practice Address - Street 1:401 43RD AVE
Practice Address - Street 2:# 204
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94121-1562
Practice Address - Country:US
Practice Address - Phone:415-336-1176
Practice Address - Fax:415-751-3310
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21416103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical