Provider Demographics
NPI:1952338097
Name:HERSH, THOMAS
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:HERSH
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 370
Mailing Address - Street 2:
Mailing Address - City:NEWFANE
Mailing Address - State:VT
Mailing Address - Zip Code:05345-0370
Mailing Address - Country:US
Mailing Address - Phone:802-365-9245
Mailing Address - Fax:802-365-9333
Practice Address - Street 1:83 RADWAY HILL RD.
Practice Address - Street 2:
Practice Address - City:NEWFANE
Practice Address - State:VT
Practice Address - Zip Code:05345
Practice Address - Country:US
Practice Address - Phone:802-365-9245
Practice Address - Fax:802-365-9333
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VTVT642103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VTOVN1668Medicaid
VT29886OtherBLUE CROSS BLUE SHIELD
MAW06267OtherBLUE CROSS BLUE SHIELD
VT288908OtherMAGELLAN
MAW06267OtherBLUE CROSS BLUE SHIELD
VTOVN1668Medicaid