Provider Demographics
NPI:1154747152
Name:THOMSON, DANA (PSY, D)
Entity type:Individual
Prefix:
First Name:DANA
Middle Name:
Last Name:THOMSON
Suffix:
Gender:F
Credentials:PSY, D
Other - Prefix:DR
Other - First Name:DANA
Other - Middle Name:
Other - Last Name:SANTOMENNA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY, D
Mailing Address - Street 1:40 LEONARD DR
Mailing Address - Street 2:
Mailing Address - City:MASSAPEQUA
Mailing Address - State:NY
Mailing Address - Zip Code:11758-7920
Mailing Address - Country:US
Mailing Address - Phone:516-655-7957
Mailing Address - Fax:
Practice Address - Street 1:350 MARTHA AVE
Practice Address - Street 2:
Practice Address - City:BELLPORT
Practice Address - State:NY
Practice Address - Zip Code:11713-1525
Practice Address - Country:US
Practice Address - Phone:516-655-7957
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-14
Last Update Date:2014-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020379103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool