Provider Demographics
NPI:1003113812
Name:TOFIAS, BRAD N (CASE MANAGER)
Entity Type:Individual
Prefix:
First Name:BRAD
Middle Name:N
Last Name:TOFIAS
Suffix:
Gender:M
Credentials:CASE MANAGER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 MEYER TER
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-3401
Mailing Address - Country:US
Mailing Address - Phone:781-828-1797
Mailing Address - Fax:
Practice Address - Street 1:3 MEYER TER
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MA
Practice Address - Zip Code:02021-3401
Practice Address - Country:US
Practice Address - Phone:781-828-1797
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-15
Last Update Date:2011-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAS12078301101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAXXH960503036OtherBLUE CROSS BLUE SHIELD HMO BLUE