Provider Demographics
NPI:1699500652
Name:DECARLI, THOMAS ANTHONY
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:ANTHONY
Last Name:DECARLI
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 1:251 E 13TH ST
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6060
Mailing Address - Country:US
Mailing Address - Phone:707-601-7088
Mailing Address - Fax:
Practice Address - Street 1:251 E 13TH ST
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6060
Practice Address - Country:US
Practice Address - Phone:707-601-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-07
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-22-61650103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst