Healthcare Provider Details

I. General information

NPI: 1003053778
Provider Name (Legal Business Name): ANXIETY PANIC PHOBIA TREATMENT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2009
Last Update Date: 01/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 MAIN ST
COTUIT MA
02635-3122
US

IV. Provider business mailing address

290 MAIN ST
COTUIT MA
02635-3122
US

V. Phone/Fax

Practice location:
  • Phone: 508-428-5772
  • Fax: 508-420-4086
Mailing address:
  • Phone: 508-428-5772
  • Fax: 508-420-4086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number2138
License Number StateMA

VIII. Authorized Official

Name: DR. THOMAS TOKARZ
Title or Position: OWNER
Credential: PHD
Phone: 508-428-5772