Provider Demographics
NPI:1811032600
Name:ST. AMAND, THOMAS HENRY (LIC AC)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:HENRY
Last Name:ST. AMAND
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:68 MAIN ST
Mailing Address - Street 2:PARK SQUARE SUITE 9
Mailing Address - City:KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04043-7006
Mailing Address - Country:US
Mailing Address - Phone:207-985-0099
Mailing Address - Fax:
Practice Address - Street 1:68 MAIN ST
Practice Address - Street 2:PARK SQUARE SUITE 9
Practice Address - City:KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04043-7006
Practice Address - Country:US
Practice Address - Phone:207-985-0099
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEAC198171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist