Provider Demographics
NPI:1760962021
Name:THOMAS, SIDNEY W
Entity Type:Individual
Prefix:
First Name:SIDNEY
Middle Name:W
Last Name:THOMAS
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 1:228 GORDY PL
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:DE
Mailing Address - Zip Code:19720-4742
Mailing Address - Country:US
Mailing Address - Phone:610-529-1933
Mailing Address - Fax:
Practice Address - Street 1:228 GORDY PL
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:DE
Practice Address - Zip Code:19720-4742
Practice Address - Country:US
Practice Address - Phone:610-529-1933
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)