Provider Demographics
NPI:1639116700
Name:KWASNIK, THOMAS P (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:P
Last Name:KWASNIK
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 1:5133 SILVERNAIL DR
Mailing Address - Street 2:
Mailing Address - City:CANANDAIGUA
Mailing Address - State:NY
Mailing Address - Zip Code:14424-8325
Mailing Address - Country:US
Mailing Address - Phone:585-394-8926
Mailing Address - Fax:
Practice Address - Street 1:5133 SILVERNAIL DR
Practice Address - Street 2:
Practice Address - City:CANANDAIGUA
Practice Address - State:NY
Practice Address - Zip Code:14424-8325
Practice Address - Country:US
Practice Address - Phone:585-394-8926
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-31
Last Update Date:2009-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007606-1103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYIA 1190Medicare PIN