Provider Demographics
NPI:1679043137
Name:PERKINS, THOMAS CS (LCSW, MED)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CS
Last Name:PERKINS
Suffix:
Gender:M
Credentials:LCSW, MED
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:CUYLER STEDMAN
Other - Last Name:PERKINS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, MED
Mailing Address - Street 1:276 5TH AVE RM 704
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-4527
Mailing Address - Country:US
Mailing Address - Phone:781-924-6072
Mailing Address - Fax:
Practice Address - Street 1:276 5TH AVE FL 11
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-4509
Practice Address - Country:US
Practice Address - Phone:617-505-8387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2022-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY104711104100000X
NY0932201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker