Healthcare Provider Details

I. General information

NPI: 1053671925
Provider Name (Legal Business Name): THOMAS JAMES MCCAFFREY
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/24/2012
Last Update Date: 06/21/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1925 ASPEN DR STE 901B
SANTA FE NM
87505-5569
US

IV. Provider business mailing address

1925 ASPEN DR STE 901B
SANTA FE NM
87505-5569
US

V. Phone/Fax

Practice location:
  • Phone: 847-471-6993
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1422
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: