Provider Demographics
NPI:1558576355
Name:VINCENT, THOMAS A (PSYD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:VINCENT
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:359 MAIN ST
Mailing Address - Street 2:SUITE #4
Mailing Address - City:HAVERHILL
Mailing Address - State:MA
Mailing Address - Zip Code:01830-4028
Mailing Address - Country:US
Mailing Address - Phone:978-373-5620
Mailing Address - Fax:978-373-0970
Practice Address - Street 1:359 MAIN ST
Practice Address - Street 2:SUITE #4
Practice Address - City:HAVERHILL
Practice Address - State:MA
Practice Address - Zip Code:01830-4028
Practice Address - Country:US
Practice Address - Phone:978-373-5620
Practice Address - Fax:978-373-0970
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1487101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health