Healthcare Provider Details

I. General information

NPI: 1184681595
Provider Name (Legal Business Name): THOMAS PHILLIP MARTIN PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

365 EAST ST
TEWKSBURY MA
01876-1950
US

IV. Provider business mailing address

48 BERRYWOOD LN
HAMILTON MA
01982-1504
US

V. Phone/Fax

Practice location:
  • Phone: 978-468-1606
  • Fax:
Mailing address:
  • Phone: 978-458-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number2122
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number2122
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: