Provider Demographics
NPI:1235353962
Name:DRISCOLL, THOMAS G (MED)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:G
Last Name:DRISCOLL
Suffix:
Gender:M
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:WINCHENDON
Mailing Address - State:MA
Mailing Address - Zip Code:01475-1268
Mailing Address - Country:US
Mailing Address - Phone:978-632-9400
Mailing Address - Fax:
Practice Address - Street 1:31 LAKE ST
Practice Address - Street 2:
Practice Address - City:GARDNER
Practice Address - State:MA
Practice Address - Zip Code:01440-3879
Practice Address - Country:US
Practice Address - Phone:978-632-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health