Provider Demographics
NPI:1417403213
Name:O'HANLON, THOMAS (LMSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:O'HANLON
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 FARMINGDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:WEST BABYLON
Mailing Address - State:NY
Mailing Address - Zip Code:11704-9003
Mailing Address - Country:US
Mailing Address - Phone:631-669-5355
Mailing Address - Fax:
Practice Address - Street 1:11 FARMINGDALE ROAD
Practice Address - Street 2:
Practice Address - City:WEST BABYLON
Practice Address - State:NY
Practice Address - Zip Code:11704-6207
Practice Address - Country:US
Practice Address - Phone:631-669-5355
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2016-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097852-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY097852-1OtherTHE UNIVERSITY OF THE STATE OF NEW YORK EDUCATION DEPARTMENT OFFICE OF THE PROFE