Provider Demographics
NPI:1336284132
Name:MANN, THOMAS DAVID (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:DAVID
Last Name:MANN
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 1:35 KINGS HWY E
Mailing Address - Street 2:SUITE 108
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-2009
Mailing Address - Country:US
Mailing Address - Phone:856-429-4557
Mailing Address - Fax:856-429-5375
Practice Address - Street 1:35 KINGS HWY E
Practice Address - Street 2:SUITE 108
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033-2009
Practice Address - Country:US
Practice Address - Phone:856-429-4557
Practice Address - Fax:856-429-5375
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00341600103T00000X
PAPS-005398-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0064793Medicaid