Healthcare Provider Details

I. General information

NPI: 1942931241
Provider Name (Legal Business Name): PATCHARAPON THAMMATHORN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LOOKNOO THAMMATHORN PH.D.

II. Dates (important events)

Enumeration Date: 06/19/2022
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 PROSPECT ST STE 6
CAMBRIDGE MA
02139-2540
US

IV. Provider business mailing address

126 PROSPECT ST STE 6
CAMBRIDGE MA
02139-2540
US

V. Phone/Fax

Practice location:
  • Phone: 617-583-3269
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY10001166
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: