Healthcare Provider Details

I. General information

NPI: 1487064713
Provider Name (Legal Business Name): DR. SARA L. THOMASON, PSYD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2014
Last Update Date: 05/08/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23 ISAAC ST
MIDDLEBORO MA
02346-2080
US

IV. Provider business mailing address

23 ISAAC ST
MIDDLEBORO MA
02346-2080
US

V. Phone/Fax

Practice location:
  • Phone: 774-419-1041
  • Fax: 774-419-1044
Mailing address:
  • Phone: 774-419-1041
  • Fax: 774-419-1044

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number9192
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number9192
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number9192
License Number StateMA

VIII. Authorized Official

Name: DR. SARA LINDSAY THOMASON
Title or Position: BUSINESS OWNER
Credential: PSYD
Phone: 774-419-1041