Provider Demographics
NPI:1982923769
Name:LETSON, THOMAS F
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:F
Last Name:LETSON
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 1:143 TANGERINE DR
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-1855
Mailing Address - Country:US
Mailing Address - Phone:732-547-2603
Mailing Address - Fax:
Practice Address - Street 1:25 KENNEDY BLVD STE 600
Practice Address - Street 2:
Practice Address - City:EAST BRUNSWICK
Practice Address - State:NJ
Practice Address - Zip Code:08816-1262
Practice Address - Country:US
Practice Address - Phone:732-547-2603
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-19
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37LC00095800101YA0400X
NJ37PC00170000101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health