Healthcare Provider Details

I. General information

NPI: 1164535530
Provider Name (Legal Business Name): THOMAS B. GAMBLE PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/17/2006
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41 LEBANON ST
HANOVER NH
03755-2147
US

IV. Provider business mailing address

PO BOX 266
EAST THETFORD VT
05043-0266
US

V. Phone/Fax

Practice location:
  • Phone: 802-785-2903
  • Fax: 802-785-2631
Mailing address:
  • Phone: 802-785-2903
  • Fax: 802-785-2631

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number632
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: