Provider Demographics
NPI:1093364457
Name:THORNTON, ERIC MATTHEW
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:MATTHEW
Last Name:THORNTON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1419 HANCOCK ST STE 202
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-5250
Mailing Address - Country:US
Mailing Address - Phone:617-770-9690
Mailing Address - Fax:617-770-9692
Practice Address - Street 1:1419 HANCOCK ST STE 202
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-5250
Practice Address - Country:US
Practice Address - Phone:617-770-9690
Practice Address - Fax:617-770-9692
Is Sole Proprietor?:No
Enumeration Date:2019-09-09
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health