Provider Demographics
NPI:1790793768
Name:THOMAS, JEFFREY ERIC (LICSW LICENSED INDEP)
Entity Type:Individual
Prefix:MR
First Name:JEFFREY
Middle Name:ERIC
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LICSW LICENSED INDEP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 GRANVILLE ROAD #1
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138
Mailing Address - Country:US
Mailing Address - Phone:617-739-1619
Mailing Address - Fax:617-383-6210
Practice Address - Street 1:1318 BEACON STREET #5
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446
Practice Address - Country:US
Practice Address - Phone:617-739-1619
Practice Address - Fax:617-383-6210
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10166801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP05544OtherBLUE CROSS
MAP05544OtherBLUE CROSS