Provider Demographics
NPI:1124186986
Name:CHIODETTI, THOMAS (EDD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:CHIODETTI
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 GIFFORD ST
Mailing Address - Street 2:SUITE 13
Mailing Address - City:FALMOUTH
Mailing Address - State:MA
Mailing Address - Zip Code:02540-2918
Mailing Address - Country:US
Mailing Address - Phone:508-457-7222
Mailing Address - Fax:508-540-5148
Practice Address - Street 1:350 GIFFORD ST
Practice Address - Street 2:SUITE 13
Practice Address - City:FALMOUTH
Practice Address - State:MA
Practice Address - Zip Code:02540-2918
Practice Address - Country:US
Practice Address - Phone:508-457-7222
Practice Address - Fax:508-540-5148
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPSYCHOLOGIST6705103T00000X, 103TA0400X, 103TA0700X, 103TC1900X, 103TC2200X, 103TE1100X, 103TF0000X, 103TP2701X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Not Answered103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Not Answered103TE1100XBehavioral Health & Social Service ProvidersPsychologistExercise & Sports
Not Answered103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
Not Answered103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Not Answered103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05410OtherBCBS
MA198339OtherMHN
MA0525383Medicaid
MA007980OtherVALUE OPTIONS
MA198339OtherMHN