Provider Demographics
NPI:1407336712
Name:BORDEN, THOMAS MICHAEL (LICSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:MICHAEL
Last Name:BORDEN
Suffix:
Gender:M
Credentials:LICSW
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 2002
Mailing Address - Street 2:
Mailing Address - City:PERU
Mailing Address - State:MA
Mailing Address - Zip Code:01235-2002
Mailing Address - Country:US
Mailing Address - Phone:413-655-2096
Mailing Address - Fax:
Practice Address - Street 1:251 FENN ST
Practice Address - Street 2:
Practice Address - City:PITTSFIELD
Practice Address - State:MA
Practice Address - Zip Code:01201-5269
Practice Address - Country:US
Practice Address - Phone:413-499-0412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10261661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty