Provider Demographics
NPI:1356495824
Name:EUSTACE, THOMAS D (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:D
Last Name:EUSTACE
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 611
Mailing Address - Street 2:
Mailing Address - City:YORKTOWN HTS
Mailing Address - State:NY
Mailing Address - Zip Code:10598-0611
Mailing Address - Country:US
Mailing Address - Phone:914-962-3442
Mailing Address - Fax:914-962-4332
Practice Address - Street 1:7 FARESE WAY
Practice Address - Street 2:
Practice Address - City:AMAWALK
Practice Address - State:NY
Practice Address - Zip Code:10501-1201
Practice Address - Country:US
Practice Address - Phone:914-962-3442
Practice Address - Fax:914-962-4332
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0059391103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
57661OtherUBH
WS167OtherOXFORD
Y047096OtherCHAMPUS
60005939NYOtherANTHEM
WS0001037OtherSELECTPRO
110726OtherMHN
NY01449958Medicaid
1034116OtherMETRACOMP
PVPB80927OtherAPS
7114043OtherAETNA
IP318503OtherMAGELLAN
V50761OtherBLUE CROSS BLUE SHIELD
003182OtherVALUE OPTIONS
25831OtherCIGNA
703156OtherMTCE
PO10005939OtherSTAMET
5C0901OtherHEALTHNET
WS0001037OtherSELECTPRO