Provider Demographics
NPI:1023363645
Name:THOMAS, SONORA ROSE (MA)
Entity Type:Individual
Prefix:
First Name:SONORA
Middle Name:ROSE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 HALL AVE FL 2
Mailing Address - Street 2:
Mailing Address - City:SOMERVILLE
Mailing Address - State:MA
Mailing Address - Zip Code:02144-2003
Mailing Address - Country:US
Mailing Address - Phone:617-875-5702
Mailing Address - Fax:
Practice Address - Street 1:61 HALL AVE FL 2
Practice Address - Street 2:
Practice Address - City:SOMERVILLE
Practice Address - State:MA
Practice Address - Zip Code:02144-2003
Practice Address - Country:US
Practice Address - Phone:617-875-5702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-19
Last Update Date:2012-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health