Provider Demographics
NPI:1386488534
Name:THOMAS, DYLAN JAMES
Entity type:Individual
Prefix:
First Name:DYLAN
Middle Name:JAMES
Last Name:THOMAS
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 1:1124 PATRIOT WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-9624
Mailing Address - Country:US
Mailing Address - Phone:856-492-1355
Mailing Address - Fax:
Practice Address - Street 1:1124 PATRIOT WAY
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-9624
Practice Address - Country:US
Practice Address - Phone:856-492-1355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-22
Last Update Date:2024-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ106E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst