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NPI Code Detail

MEDICARE: THOMAS B DANFORTH PH.D.

MEDICARE: THOMAS B DANFORTH PH.D.
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
1103TC1900XCounseling Psychologist7626MA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1WO5955OTHERMABC BS OF MASSACHUSETTS
2007626OTHERMATUFTS HEALTH PLAN

General Provider Information

NPI Number : 1659312544
Entity Type Code : Individual
Provider Name (Legal Business Name) : THOMAS B DANFORTH PH.D.
Provider Business Mailing Address
First Line : 66 MAIN ST
Second Line :
City : NORTH EASTON
State : MA
Zip : 02356-1443
Country : US
Telephone Number : 508-238-7766
Fax Number : 508-230-5089
Provider Business Practice Location Address
First Line : 66 MAIN ST
Second Line :
City : NORTH EASTON
State : MA
Zip : 02356-1443
Country : US
Telephone Number : 508-238-7766
Fax Number : 508-230-5089
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2006
Last Update Date : 07/08/2007

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Directions to “ THOMAS B DANFORTH PH.D.” Practice Location

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