Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TS0200X | School Psychologist | 005240 | AZ |
NPI | 1043824329 |
---|---|
Provider Name | Dr. Thomas J Gambrel |
First Address | Phoenix, AZ 85020-4147 |
Second Address | Phoenix, AZ 85016-7498 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2020 |
Last Update Date | 03/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
UNKNOWN | (05) | AZ |