Provider Demographics
NPI:1316507676
Name:THOMAS, NICOLE GENEVIEVE (INTERN)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:GENEVIEVE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 GREEN ST
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MA
Mailing Address - Zip Code:02021-1004
Mailing Address - Country:US
Mailing Address - Phone:562-234-8411
Mailing Address - Fax:
Practice Address - Street 1:135 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2582
Practice Address - Country:US
Practice Address - Phone:508-615-6628
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health