Provider Demographics
NPI:1336264514
Name:BARRETT, THOMAS CHARLES (PHD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:CHARLES
Last Name:BARRETT
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:250 KINGS ROAD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940
Mailing Address - Country:US
Mailing Address - Phone:973-301-0442
Mailing Address - Fax:
Practice Address - Street 1:268 GREEN VILLAGE ROAD
Practice Address - Street 2:
Practice Address - City:GREEN VILLAGE
Practice Address - State:NJ
Practice Address - Zip Code:07935
Practice Address - Country:US
Practice Address - Phone:973-301-0442
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00286400103T00000X, 103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Not Answered103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
R06390Medicare UPIN
NJBA472353Medicare ID - Type Unspecified