MEDICARE: DR. THOMAS A. CAFFREY PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	005261-1	NY
2	103TF0200X	Forensic Psychologist	005261-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11558968	OTHER	NY	CAQH PROVIDER ID
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	816	OTHER	AL	CERTIFICATE PROFESSIONAL QUALIFICATION (CPQ) PSYCHOLOGY

General Provider Information

NPI Number	:	1669417390
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. THOMAS A. CAFFREY PH.D.

Provider Business Mailing Address
First Line	:	1841 BROADWAY
Second Line	:	SUITE 702
City	:	NEW YORK
State	:	NY
Zip	:	10023-7603
Country	:	US
Telephone Number	:	212-977-3189
Fax Number	:	646-289-5138

Provider Business Practice Location Address
First Line	:	1841 BROADWAY
Second Line	:	SUITE 702
City	:	NEW YORK
State	:	NY
Zip	:	10023-7603
Country	:	US
Telephone Number	:	212-977-3189
Fax Number	:	646-289-5138

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/17/2006
Last Update Date	:	10/04/2010

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