Provider Demographics
NPI:1861484354
Name:THOMAS, JOHN BRAINERD JR (MSW)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:BRAINERD
Last Name:THOMAS
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:278 QUAKER LN N
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1037
Mailing Address - Country:US
Mailing Address - Phone:860-523-0305
Mailing Address - Fax:860-714-8531
Practice Address - Street 1:968 FARMINGTON AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2172
Practice Address - Country:US
Practice Address - Phone:860-523-0288
Practice Address - Fax:860-714-8531
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0006931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical