Provider Demographics
NPI:1013008994
Name:THOMAS, KATHRYN W (PHD)
Entity Type:Individual
Prefix:DR
First Name:KATHRYN
Middle Name:W
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:KATHRYN
Other - Middle Name:S
Other - Last Name:WULLNER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 1126
Mailing Address - Street 2:
Mailing Address - City:BATH
Mailing Address - State:ME
Mailing Address - Zip Code:04530
Mailing Address - Country:US
Mailing Address - Phone:207-729-9671
Mailing Address - Fax:207-442-7396
Practice Address - Street 1:98 MAINE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-729-9671
Practice Address - Fax:209-442-7396
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPSY889103T00000X
CAPSY13325103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist