MEDICARE: DR. NIKLOS JAMES TOMICH PSY.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
1	103TC0700X	Clinical Psychologist	4687	MA

Other Identifiers

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

General Provider Information

NPI Number	:	1750500732
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NIKLOS JAMES TOMICH PSY.D.

Provider Business Mailing Address
First Line	:	110 HART ST
Second Line	:
City	:	BEVERLY
State	:	MA
Zip	:	01915-2151
Country	:	US
Telephone Number	:	978-927-0638
Fax Number	:	978-927-0638

Provider Business Practice Location Address
First Line	:	1419 HANCOCK ST
Second Line	:
City	:	QUINCY
State	:	MA
Zip	:	02169-5250
Country	:	US
Telephone Number	:	617-472-1541
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/25/2007
Last Update Date	:	07/08/2007

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