Healthcare Provider Details

I. General information

NPI: 1225698301
Provider Name (Legal Business Name): THOMAS MCCAFFREY PSYD LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/19/2019
Last Update Date: 07/24/2019
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: 847-471-6993
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: DR. THOMAS J MCCAFFREY
Title or Position: CEO
Credential:
Phone: 847-471-6993