Provider Demographics
NPI:1851372247
Name:LACHIUSA, THOMAS A (PHD LICSW)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:LACHIUSA
Suffix:
Gender:M
Credentials:PHD LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 CONVERSE ST
Mailing Address - Street 2:CONVERSE PROFESSIONAL BUILDING
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1760
Mailing Address - Country:US
Mailing Address - Phone:413-567-4200
Mailing Address - Fax:413-567-8935
Practice Address - Street 1:1200 CONVERSE ST
Practice Address - Street 2:CONVERSE PROFESSIONAL BUILDING
Practice Address - City:LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01106-1760
Practice Address - Country:US
Practice Address - Phone:413-567-4200
Practice Address - Fax:413-567-8935
Is Sole Proprietor?:No
Enumeration Date:2005-11-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10207501041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MALAP20196Medicare ID - Type Unspecified