Provider Demographics
NPI:1922411487
Name:NET, THAVRA SO
Entity Type:Individual
Prefix:
First Name:THAVRA
Middle Name:SO
Last Name:NET
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 SYLVAN ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-3558
Mailing Address - Country:US
Mailing Address - Phone:978-774-6820
Mailing Address - Fax:978-777-4242
Practice Address - Street 1:152 SYLVAN ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3558
Practice Address - Country:US
Practice Address - Phone:978-774-6820
Practice Address - Fax:978-777-4242
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health