Provider Demographics
NPI:1912900424
Name:DORRANCE, THOMAS W (MSW)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:W
Last Name:DORRANCE
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 DAMONMILL SQ
Mailing Address - Street 2:SUITE 4 A 1
Mailing Address - City:CONCORD
Mailing Address - State:MA
Mailing Address - Zip Code:01742-2858
Mailing Address - Country:US
Mailing Address - Phone:978-369-6737
Mailing Address - Fax:
Practice Address - Street 1:9 DAMONMILL SQ
Practice Address - Street 2:SUITE 4 A 1
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2858
Practice Address - Country:US
Practice Address - Phone:978-369-6737
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1049071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP03088OtherBLUE CROSS BLUE SHIELD
MAP03088OtherBLUE CROSS BLUE SHIELD