Provider Demographics
NPI:1134950157
Name:LUST, THOMAS JAMES (MSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:JAMES
Last Name:LUST
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WEST CHESTER
Mailing Address - State:PA
Mailing Address - Zip Code:19382-2739
Mailing Address - Country:US
Mailing Address - Phone:855-687-2410
Mailing Address - Fax:833-687-2414
Practice Address - Street 1:239 E MARKET ST
Practice Address - Street 2:
Practice Address - City:WEST CHESTER
Practice Address - State:PA
Practice Address - Zip Code:19382-2739
Practice Address - Country:US
Practice Address - Phone:855-687-2410
Practice Address - Fax:833-687-2414
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility