1336495423 NPI number — CAITLIN BURBRIDGE THUNFORS PH.D.

Table of content: CAITLIN BURBRIDGE THUNFORS PH.D. (NPI 1336495423)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336495423 NPI number — CAITLIN BURBRIDGE THUNFORS PH.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THUNFORS
Provider First Name:
CAITLIN
Provider Middle Name:
BURBRIDGE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1336495423
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
280 CHESTNUT ST
Provider Second Line Business Mailing Address:
2ND FLOOR
Provider Business Mailing Address City Name:
SPRINGFIELD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01199-1619
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-794-5700
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
470 GRANBY RD
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
SOUTH HADLEY
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01075-3218
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-533-3926
Provider Business Practice Location Address Fax Number:
413-794-8732
Provider Enumeration Date:
07/26/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103T00000X , with the licence number:  9879 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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