Healthcare Provider Details

I. General information

NPI: 1295196327
Provider Name (Legal Business Name): MONICA THOMAS PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/17/2016
Last Update Date: 07/10/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

169 PUTNAM HALL DEPARTMENT OF PSYCHIATRY
STONY BROOK NY
11794-5528
US

IV. Provider business mailing address

169 PUTNAM HALL DEPARTMENT OF PSYCHIATRY
STONY BROOK NY
11794-5528
US

V. Phone/Fax

Practice location:
  • Phone: 631-632-2428
  • Fax: 631-216-8319
Mailing address:
  • Phone: 631-632-2428
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0400X
TaxonomyAddiction (Substance Use Disorder) Psychologist
License Number021855
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: