Provider Demographics
NPI:1417984691
Name:HULTZMAN, THOMAS P (LICSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:P
Last Name:HULTZMAN
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 1:621 MAIN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5668
Mailing Address - Country:US
Mailing Address - Phone:508-841-8189
Mailing Address - Fax:508-841-8189
Practice Address - Street 1:621 MAIN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SHREWSBURY
Practice Address - State:MA
Practice Address - Zip Code:01545-5668
Practice Address - Country:US
Practice Address - Phone:508-841-8189
Practice Address - Fax:508-841-8189
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10326191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP23407Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER