Provider Demographics
NPI:1780990648
Name:SPIWAK, THOMAS L (MS, LPC)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:L
Last Name:SPIWAK
Suffix:
Gender:M
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:95 RAFFIA RD
Mailing Address - Street 2:
Mailing Address - City:ENFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06082-5100
Mailing Address - Country:US
Mailing Address - Phone:860-749-9298
Mailing Address - Fax:
Practice Address - Street 1:95 RAFFIA RD
Practice Address - Street 2:
Practice Address - City:ENFIELD
Practice Address - State:CT
Practice Address - Zip Code:06082-5100
Practice Address - Country:US
Practice Address - Phone:860-749-9298
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-29
Last Update Date:2010-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001970101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional