Provider Demographics
NPI:1780790709
Name:DAVEY, THOMAS (EDD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:DAVEY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 STARR LN
Mailing Address - Street 2:
Mailing Address - City:JAMAICA PLAIN
Mailing Address - State:MA
Mailing Address - Zip Code:02130-2845
Mailing Address - Country:US
Mailing Address - Phone:617-266-4960
Mailing Address - Fax:617-266-4960
Practice Address - Street 1:305 NEWBURY ST STE 42
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02115-2833
Practice Address - Country:US
Practice Address - Phone:617-266-4960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4236103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW04150Medicare ID - Type Unspecified