Provider Demographics
NPI:1225398126
Name:THOMA, NATHAN C (PHD)
Entity Type:Individual
Prefix:MR
First Name:NATHAN
Middle Name:C
Last Name:THOMA
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 1:10 E 40TH ST
Mailing Address - Street 2:SUITE 3210
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-0200
Mailing Address - Country:US
Mailing Address - Phone:347-778-1801
Mailing Address - Fax:
Practice Address - Street 1:10 E 40TH ST
Practice Address - Street 2:SUITE 3210
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-0200
Practice Address - Country:US
Practice Address - Phone:347-778-1801
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-24
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019591103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical