Healthcare Provider Details

I. General information

NPI: 1801556790
Provider Name (Legal Business Name): THOMAS P HENNESSY MA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2021
Last Update Date: 12/20/2021
Certification Date: 12/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9000 E NICHOLS AVE STE 104
CENTENNIAL CO
80112-3429
US

IV. Provider business mailing address

1 GARDEN TER # 26A
NORTH ARLINGTON NJ
07031-6200
US

V. Phone/Fax

Practice location:
  • Phone: 700-996-1735
  • Fax:
Mailing address:
  • Phone: 732-610-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: