Provider Demographics
NPI:1679705388
Name:DUKE, THOMAS CHARLES (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:CHARLES
Last Name:DUKE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:299 N EUCLID AVE STE 500
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-1468
Mailing Address - Country:US
Mailing Address - Phone:626-344-6732
Mailing Address - Fax:
Practice Address - Street 1:299 N EUCLID AVE STE 500
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1468
Practice Address - Country:US
Practice Address - Phone:626-344-6732
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-13
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA28069103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist