Provider Demographics
NPI:1003053778
Name:ANXIETY PANIC PHOBIA TREATMENT CENTER
Entity Type:Organization
Organization Name:ANXIETY PANIC PHOBIA TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:TOKARZ
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:508-428-5772
Mailing Address - Street 1:290 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTUIT
Mailing Address - State:MA
Mailing Address - Zip Code:02635-3122
Mailing Address - Country:US
Mailing Address - Phone:508-428-5772
Mailing Address - Fax:508-420-4086
Practice Address - Street 1:290 MAIN ST
Practice Address - Street 2:
Practice Address - City:COTUIT
Practice Address - State:MA
Practice Address - Zip Code:02635-3122
Practice Address - Country:US
Practice Address - Phone:508-428-5772
Practice Address - Fax:508-420-4086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-16
Last Update Date:2009-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2138103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA687753OtherTUFTS HEALTH PLAN
MA=========OtherUBH