Provider Demographics
NPI:1124146121
Name:STACKHOUSE, THOMAS (PHD)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:STACKHOUSE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 WEBSTER ST STE 8
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:MA
Mailing Address - Zip Code:02339-1227
Mailing Address - Country:US
Mailing Address - Phone:781-754-6545
Mailing Address - Fax:508-999-6607
Practice Address - Street 1:466 COUNTY ST
Practice Address - Street 2:
Practice Address - City:NEW BEDFORD
Practice Address - State:MA
Practice Address - Zip Code:02740-5107
Practice Address - Country:US
Practice Address - Phone:508-997-0794
Practice Address - Fax:508-999-6607
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2023-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2679103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2679OtherPSYCHOLOGIST LICENSE
MA2679OtherPSYCHOLOGIST LICENSE