Provider Demographics
NPI:1487270484
Name:POWER, THOMAS C
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:C
Last Name:POWER
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 1:338 N 15TH ST
Mailing Address - Street 2:
Mailing Address - City:OLEAN
Mailing Address - State:NY
Mailing Address - Zip Code:14760-2027
Mailing Address - Country:US
Mailing Address - Phone:716-375-4751
Mailing Address - Fax:716-375-4779
Practice Address - Street 1:338 N 15TH ST
Practice Address - Street 2:
Practice Address - City:OLEAN
Practice Address - State:NY
Practice Address - Zip Code:14760-2027
Practice Address - Country:US
Practice Address - Phone:716-375-4751
Practice Address - Fax:716-375-4779
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2020-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY109006-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker