Provider Demographics
NPI:1932981164
Name:NATALIE THOME, LICENSED CLINICAL SOCIAL WORKER, INC.
Entity Type:Organization
Organization Name:NATALIE THOME, LICENSED CLINICAL SOCIAL WORKER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:NATALIE
Authorized Official - Middle Name:GORBUNOFF
Authorized Official - Last Name:THOME
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:510-701-4441
Mailing Address - Street 1:407 N PACIFIC COAST HWY UNIT 216
Mailing Address - Street 2:
Mailing Address - City:REDONDO BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90277-2872
Mailing Address - Country:US
Mailing Address - Phone:510-701-4441
Mailing Address - Fax:
Practice Address - Street 1:806 MANHATTAN BEACH BLVD STE 207
Practice Address - Street 2:
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-4961
Practice Address - Country:US
Practice Address - Phone:310-376-3388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty