Provider Demographics
NPI:1407367840
Name:CARIVEAU, THOMAS (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:CARIVEAU
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:DR
Other - First Name:TOM
Other - Middle Name:
Other - Last Name:CARIVEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:720 SAINT JAMES DR
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:NC
Mailing Address - Zip Code:28403-2937
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:720 SAINT JAMES DR
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:NC
Practice Address - Zip Code:28403-2937
Practice Address - Country:US
Practice Address - Phone:910-660-8200
Practice Address - Fax:910-660-8199
Is Sole Proprietor?:No
Enumeration Date:2017-10-12
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1-15-21039103K00000X
NC5215103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst