Healthcare Provider Details

I. General information

NPI: 1538872304
Provider Name (Legal Business Name): SKY THOMAS MT-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2022
Last Update Date: 03/27/2024
Certification Date: 03/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 BRADSTON ST
BOSTON MA
02118-2703
US

IV. Provider business mailing address

23 BRADSTON ST FL 1
BOSTON MA
02118-2703
US

V. Phone/Fax

Practice location:
  • Phone: 617-318-6480
  • Fax: 617-427-1263
Mailing address:
  • Phone: 617-318-6480
  • Fax: 617-427-1263

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number17199
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: