Provider Demographics
NPI:1043396492
Name:THURBER, THOMAS ALFRED (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:ALFRED
Last Name:THURBER
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:391 BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MERIDEN
Mailing Address - State:CT
Mailing Address - Zip Code:06450-5844
Mailing Address - Country:US
Mailing Address - Phone:203-634-3546
Mailing Address - Fax:203-237-9679
Practice Address - Street 1:391 BROAD ST
Practice Address - Street 2:
Practice Address - City:MERIDEN
Practice Address - State:CT
Practice Address - Zip Code:06450-5844
Practice Address - Country:US
Practice Address - Phone:203-634-3546
Practice Address - Fax:203-237-9679
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001822101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health