1902820731 NPI number — THOMAS F DOHERTY PH.D, LICSW

Table of content: THOMAS F DOHERTY PH.D, LICSW (NPI 1902820731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902820731 NPI number — THOMAS F DOHERTY PH.D, LICSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
DOHERTY
Provider First Name:
THOMAS
Provider Middle Name:
F
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PH.D, LICSW
Provider Gender Code:
M

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:
1902820731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
825 WASHINGTON ST
Provider Second Line Business Mailing Address:
SUITE 265
Provider Business Mailing Address City Name:
NORWOOD
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02062-3441
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
781-762-6141
Provider Business Mailing Address Fax Number:
781-762-4713

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
825 WASHINGTON ST
Provider Second Line Business Practice Location Address:
SUITE 265
Provider Business Practice Location Address City Name:
NORWOOD
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02062-3441
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
781-762-6141
Provider Business Practice Location Address Fax Number:
781-762-4713
Provider Enumeration Date:
07/26/2006

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: 103TC1900X , with the licence number:  103047 , 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)

  • Identifier: 2010230 . This is a "CIGNA HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2554999000 . This is a "MAGELLAN BEHAVIORAL HEALT" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 761579 . This is a "TUFTS HEALTH CARE" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: S029382 . This is a "CHAMPUS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com