Provider Demographics
NPI:1689785354
Name:ARZT, THOMAS A (LCSW, BCD)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:ARZT
Suffix:
Gender:M
Credentials:LCSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:640 BELLE TERRE RD
Mailing Address - Street 2:BUILDING D, SUITE 3
Mailing Address - City:PORT JEFFERSON
Mailing Address - State:NY
Mailing Address - Zip Code:11777-2316
Mailing Address - Country:US
Mailing Address - Phone:631-928-0900
Mailing Address - Fax:631-473-4760
Practice Address - Street 1:640 BELLE TERRE RD
Practice Address - Street 2:BUILDING D, SUITE 3
Practice Address - City:PORT JEFFERSON
Practice Address - State:NY
Practice Address - Zip Code:11777-2316
Practice Address - Country:US
Practice Address - Phone:631-928-0900
Practice Address - Fax:631-473-4760
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-31
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR017565-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN47141Medicare UPIN