Provider Demographics
NPI:1497892434
Name:DESMOND, THOMAS EDDY (MA, LPC, NCC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:EDDY
Last Name:DESMOND
Suffix:
Gender:M
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:EAST HARTLAND
Mailing Address - State:CT
Mailing Address - Zip Code:06027-1603
Mailing Address - Country:US
Mailing Address - Phone:860-653-3839
Mailing Address - Fax:
Practice Address - Street 1:255 SOUTH RD
Practice Address - Street 2:
Practice Address - City:EAST HARTLAND
Practice Address - State:CT
Practice Address - Zip Code:06027-1603
Practice Address - Country:US
Practice Address - Phone:860-653-3839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional