Provider Demographics
NPI:1679541759
Name:LANDRY, THOMAS M (LCSW)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:LANDRY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1209 E END AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-1309
Mailing Address - Country:US
Mailing Address - Phone:412-371-1501
Mailing Address - Fax:
Practice Address - Street 1:PITTSBURGH PASTORAL INSTITUTE
Practice Address - Street 2:6324 MARCHAND ST
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15206
Practice Address - Country:US
Practice Address - Phone:412-661-1239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2009-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW000398L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA001461923OtherHIGHMARK BLUE CROSS