Provider Demographics
NPI:1972658409
Name:THOMAS, ANDREW TODD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:TODD
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 INWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07043-1908
Mailing Address - Country:US
Mailing Address - Phone:973-783-6977
Mailing Address - Fax:973-783-6597
Practice Address - Street 1:183 INWOOD AVE
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07043-1908
Practice Address - Country:US
Practice Address - Phone:973-783-6977
Practice Address - Fax:973-783-6597
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSI03635101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ7821409Medicaid