Provider Demographics
NPI:1588753776
Name:THORP, CATHERINE OLA (PMHCNS-BC)
Entity type:Individual
Prefix:MS
First Name:CATHERINE
Middle Name:OLA
Last Name:THORP
Suffix:
Gender:F
Credentials:PMHCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 ELM ST STE 100
Mailing Address - Street 2:
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01609-1903
Mailing Address - Country:US
Mailing Address - Phone:508-753-1056
Mailing Address - Fax:508-753-1785
Practice Address - Street 1:130 ELM ST STE 100
Practice Address - Street 2:
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01609-1903
Practice Address - Country:US
Practice Address - Phone:508-753-1056
Practice Address - Fax:508-753-1785
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA190234364SP0807X, 364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0807XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Child & Adolescent
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
MATHNS0333Medicare ID - Type Unspecified