Provider Demographics
NPI:1518159219
Name:BURWELL, THOMAS (MS)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:BURWELL
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2032
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:NH
Mailing Address - Zip Code:03302-2032
Mailing Address - Country:US
Mailing Address - Phone:603-228-0547
Mailing Address - Fax:
Practice Address - Street 1:105 LOUDON RD
Practice Address - Street 2:BUILDING 3
Practice Address - City:CONCORD
Practice Address - State:NH
Practice Address - Zip Code:03301-5601
Practice Address - Country:US
Practice Address - Phone:603-228-0547
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health