Provider Demographics
NPI:1770913568
Name:THOMAS, MICHAEL (PSYD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 CRICKET AVE
Mailing Address - Street 2:APT B
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-2035
Mailing Address - Country:US
Mailing Address - Phone:610-724-3505
Mailing Address - Fax:
Practice Address - Street 1:830 CRICKET AVE
Practice Address - Street 2:APT B
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-2035
Practice Address - Country:US
Practice Address - Phone:610-724-3505
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-15
Last Update Date:2013-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017235103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist