Provider Demographics
NPI:1417575622
Name:BREWER, THOMAS ANDERSON (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:ANDERSON
Last Name:BREWER
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 1:2 NEPTUNE RD STE 424
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1457
Mailing Address - Country:US
Mailing Address - Phone:617-798-0924
Mailing Address - Fax:
Practice Address - Street 1:2 NEPTUNE RD STE 424
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-1457
Practice Address - Country:US
Practice Address - Phone:617-798-0924
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11388103TC0700X
103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical