Provider Demographics
NPI:1669417390
Name:CAFFREY, THOMAS A (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:A
Last Name:CAFFREY
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 1:1841 BROADWAY
Mailing Address - Street 2:SUITE 702
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-7603
Mailing Address - Country:US
Mailing Address - Phone:212-977-3189
Mailing Address - Fax:646-289-5138
Practice Address - Street 1:1841 BROADWAY
Practice Address - Street 2:SUITE 702
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7603
Practice Address - Country:US
Practice Address - Phone:212-977-3189
Practice Address - Fax:646-289-5138
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-17
Last Update Date:2010-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY005261-1103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY11558968OtherCAQH PROVIDER ID
NY00910081Medicaid
AL816OtherCERTIFICATE PROFESSIONAL QUALIFICATION (CPQ) PSYCHOLOGY
AL816OtherCERTIFICATE PROFESSIONAL QUALIFICATION (CPQ) PSYCHOLOGY