Provider Demographics
NPI:1417258377
Name:STANDISH, THOMAS R (MSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:R
Last Name:STANDISH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 GRANDVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-1123
Mailing Address - Country:US
Mailing Address - Phone:614-361-6941
Mailing Address - Fax:614-258-5719
Practice Address - Street 1:825 GRANDVIEW AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-1123
Practice Address - Country:US
Practice Address - Phone:614-361-6941
Practice Address - Fax:614-258-5719
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-09
Last Update Date:2010-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI00046381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical