Provider Demographics
NPI:1851732606
Name:THOMAS, PERRY MICHAEL
Entity type:Individual
Prefix:MR
First Name:PERRY
Middle Name:MICHAEL
Last Name:THOMAS
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 1:1931 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1105
Mailing Address - Country:US
Mailing Address - Phone:510-666-9552
Mailing Address - Fax:510-666-0987
Practice Address - Street 1:1931 CENTER ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1105
Practice Address - Country:US
Practice Address - Phone:510-666-9552
Practice Address - Fax:510-666-0987
Is Sole Proprietor?:No
Enumeration Date:2013-07-09
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CALCSW1238241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00OtherAC BHCS CLINICIAN #00