Provider Demographics
NPI:1184766529
Name:SORENSEN, THOMAS EDWIN (PSYD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:EDWIN
Last Name:SORENSEN
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5743 CORSA AVE
Mailing Address - Street 2:STE. 103
Mailing Address - City:WESTLAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-7312
Mailing Address - Country:US
Mailing Address - Phone:805-368-7991
Mailing Address - Fax:805-375-2358
Practice Address - Street 1:5743 CORSA AVE
Practice Address - Street 2:STE. 103
Practice Address - City:WESTLAKE
Practice Address - State:CA
Practice Address - Zip Code:91362-7312
Practice Address - Country:US
Practice Address - Phone:805-368-7991
Practice Address - Fax:805-375-2358
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2010-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 20140103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q 42804Medicare UPIN
CACP20140Medicare PIN
CP 20140Medicare PIN