Provider Demographics
NPI:1679665236
Name:SUNDERMAN, THOMAS JAY
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAY
Last Name:SUNDERMAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 CUMMINGS CTR
Mailing Address - Street 2:SUITE 266T
Mailing Address - City:BEVERLY
Mailing Address - State:MA
Mailing Address - Zip Code:01915-6175
Mailing Address - Country:US
Mailing Address - Phone:978-921-1190
Mailing Address - Fax:978-927-3724
Practice Address - Street 1:800 CUMMINGS CTR
Practice Address - Street 2:SUITE 266T
Practice Address - City:BEVERLY
Practice Address - State:MA
Practice Address - Zip Code:01915-6175
Practice Address - Country:US
Practice Address - Phone:978-921-1190
Practice Address - Fax:978-927-3724
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health