Provider Demographics
NPI:1164535530
Name:GAMBLE, THOMAS B (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:B
Last Name:GAMBLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 266
Mailing Address - Street 2:
Mailing Address - City:EAST THETFORD
Mailing Address - State:VT
Mailing Address - Zip Code:05043-0266
Mailing Address - Country:US
Mailing Address - Phone:802-785-2903
Mailing Address - Fax:802-785-2631
Practice Address - Street 1:41 LEBANON ST
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:NH
Practice Address - Zip Code:03755-2147
Practice Address - Country:US
Practice Address - Phone:802-785-2903
Practice Address - Fax:802-785-2631
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2012-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH632103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical