Healthcare Provider Details

I. General information

NPI: 1215858691
Provider Name (Legal Business Name): HELEN THAI PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 BOWDOIN SQ
BOSTON MA
02114-2927
US

IV. Provider business mailing address

304 GALLANTRY WAY
STITTSVILLE ONTARIO
K2S0P8
CA

V. Phone/Fax

Practice location:
  • Phone: 613-983-3379
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: