Provider Demographics
NPI:1508085572
Name:TYSON, THOMAS S (PHD)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:S
Last Name:TYSON
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 1:13 LACY CT
Mailing Address - Street 2:
Mailing Address - City:BLUE POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11715-1610
Mailing Address - Country:US
Mailing Address - Phone:631-363-8946
Mailing Address - Fax:
Practice Address - Street 1:13 LACY CT
Practice Address - Street 2:
Practice Address - City:BLUE POINT
Practice Address - State:NY
Practice Address - Zip Code:11715-1610
Practice Address - Country:US
Practice Address - Phone:631-363-8946
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY014216103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling