Provider Demographics
NPI:1922320159
Name:HARWOOD, THOMAS MARK (PH D)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:MARK
Last Name:HARWOOD
Suffix:
Gender:M
Credentials:PH D
Other - Prefix:DR
Other - First Name:T.
Other - Middle Name:MARK
Other - Last Name:HARWOOD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:28W641 INDIAN KNOLL RD
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-1705
Mailing Address - Country:US
Mailing Address - Phone:630-520-0685
Mailing Address - Fax:630-520-0685
Practice Address - Street 1:28W641 INDIAN KNOLL RD
Practice Address - Street 2:
Practice Address - City:WEST CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60185-1705
Practice Address - Country:US
Practice Address - Phone:630-520-0685
Practice Address - Fax:630-520-0685
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-15
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071.007550103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL12037089OtherUNIVERSAL PROVIDER DATA SOURCE