Provider Demographics
NPI:1487640603
Name:THOMAS, WILLIAM D (MS)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 CURTIS DR
Mailing Address - Street 2:
Mailing Address - City:CARLISLE
Mailing Address - State:PA
Mailing Address - Zip Code:17013-2105
Mailing Address - Country:US
Mailing Address - Phone:717-249-1419
Mailing Address - Fax:717-249-1244
Practice Address - Street 1:10 CURTIS DR
Practice Address - Street 2:
Practice Address - City:CARLISLE
Practice Address - State:PA
Practice Address - Zip Code:17013-2105
Practice Address - Country:US
Practice Address - Phone:717-249-1419
Practice Address - Fax:717-249-1244
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS002630L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA4101466205Medicaid
PA4101466205Medicaid