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NPI Code Detail

MEDICARE: GRACE THOMAS LPC

MEDICARE: GRACE THOMAS LPC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YP2500XProfessional Counselor002279CT

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366787673
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE THOMAS LPC
Provider Business Mailing Address
First Line : 949 BRIDGEPORT AVE
Second Line :
City : MILFORD
State : CT
Zip : 06460-3142
Country : US
Telephone Number : 203-878-6365
Fax Number : 203-301-2397
Provider Business Practice Location Address
First Line : 949 BRIDGEPORT AVE
Second Line :
City : MILFORD
State : CT
Zip : 06460-3142
Country : US
Telephone Number : 203-878-6365
Fax Number : 203-301-2397
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/28/2012
Last Update Date : 01/22/2026

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