Provider Demographics
NPI:1255020418
Name:THUMBAGE, CHANDASIRI (RBT)
Entity type:Individual
Prefix:MR
First Name:CHANDASIRI
Middle Name:
Last Name:THUMBAGE
Suffix:
Gender:M
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2360 CHAUCER ST
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33765-4203
Mailing Address - Country:US
Mailing Address - Phone:815-451-2865
Mailing Address - Fax:
Practice Address - Street 1:1501 N BELCHER RD STE 249
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33765-1300
Practice Address - Country:US
Practice Address - Phone:727-799-3330
Practice Address - Fax:727-799-9204
Is Sole Proprietor?:No
Enumeration Date:2023-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRBT-23-271325106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician