Provider Demographics
NPI:1275852295
Name:THOMAS, ATHEA
Entity Type:Individual
Prefix:
First Name:ATHEA
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1670 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-1281
Mailing Address - Country:US
Mailing Address - Phone:718-375-1200
Mailing Address - Fax:718-382-3358
Practice Address - Street 1:819 GRAND ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11211-5001
Practice Address - Country:US
Practice Address - Phone:718-388-5176
Practice Address - Fax:718-388-5169
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-01
Last Update Date:2010-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker