Provider Demographics
NPI:1497930481
Name:SCHWARTZ, THOMAS P (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:SCHWARTZ
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 1:914 S 31ST ST
Mailing Address - Street 2:
Mailing Address - City:SPEARFISH
Mailing Address - State:SD
Mailing Address - Zip Code:57783-9797
Mailing Address - Country:US
Mailing Address - Phone:201-410-3514
Mailing Address - Fax:
Practice Address - Street 1:115 N 7TH ST
Practice Address - Street 2:STE 6
Practice Address - City:SPEARFISH
Practice Address - State:SD
Practice Address - Zip Code:57783-2700
Practice Address - Country:US
Practice Address - Phone:605-645-0100
Practice Address - Fax:605-717-1009
Is Sole Proprietor?:No
Enumeration Date:2008-01-08
Last Update Date:2015-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD518103G00000X, 103TC0700X, 103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD2007759Medicaid
SD2007759Medicaid
SDS109854Medicare PIN