Provider Demographics
NPI:1063297224
Name:LELACHE, THOMAS HENRY
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:HENRY
Last Name:LELACHE
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 1:104 SHADY LN
Mailing Address - Street 2:
Mailing Address - City:HAMMONTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08037-9413
Mailing Address - Country:US
Mailing Address - Phone:856-332-1381
Mailing Address - Fax:
Practice Address - Street 1:104 SHADY LN
Practice Address - Street 2:
Practice Address - City:HAMMONTON
Practice Address - State:NJ
Practice Address - Zip Code:08037-9413
Practice Address - Country:US
Practice Address - Phone:856-332-1381
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician