Provider Demographics
NPI:1780729343
Name:STERN, THOMAS O (MSW LSW LMFT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:O
Last Name:STERN
Suffix:
Gender:M
Credentials:MSW LSW LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1645 LIBERTY ST SE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97302-4347
Mailing Address - Country:US
Mailing Address - Phone:503-399-8518
Mailing Address - Fax:503-588-5327
Practice Address - Street 1:1645 LIBERTY ST SE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97302-4347
Practice Address - Country:US
Practice Address - Phone:503-399-8518
Practice Address - Fax:503-588-5327
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL00591041C0700X
ORTO128106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000THLBGMedicare UPIN