Provider Demographics
NPI:1003030479
Name:BARTLETT, THOMAS A
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:A
Last Name:BARTLETT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19146-1518
Mailing Address - Country:US
Mailing Address - Phone:215-732-3103
Mailing Address - Fax:215-732-8584
Practice Address - Street 1:1735 LOMBARD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19146-1518
Practice Address - Country:US
Practice Address - Phone:215-732-3103
Practice Address - Fax:215-732-8584
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS005737L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical