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General NPI Number Information
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NPI Number | 1992874978
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Entity Type | Individual
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Provider Name | THADDEUS RONALD MOGILNICKI ED.D.
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Gender | Male
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Dates
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Enumeration Date | 11/06/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 323 COURT ST
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City | PLYMOUTH
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State | MA
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Zip | 02360-4322
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Country | US
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Telephone | 508-747-2718
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Fax | 508-747-5209
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Provider Business Mailing Address
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Address Line | 12 SHAWME RD
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City | SANDWICH
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State | MA
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Zip | 02563-2336
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Country | US
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Telephone | 508-888-4721
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Fax | 508-747-5209
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 912
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License Number State | MA
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