Provider Demographics
NPI:1104300292
Name:PETROUSKI, THOMAS (PSYD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:
Last Name:PETROUSKI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 FORGE RD
Mailing Address - Street 2:
Mailing Address - City:ASSONET
Mailing Address - State:MA
Mailing Address - Zip Code:02702-1426
Mailing Address - Country:US
Mailing Address - Phone:401-241-2059
Mailing Address - Fax:
Practice Address - Street 1:2 FORGE RD
Practice Address - Street 2:
Practice Address - City:ASSONET
Practice Address - State:MA
Practice Address - Zip Code:02702-1426
Practice Address - Country:US
Practice Address - Phone:401-241-2059
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA7775103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist