Provider Demographics
NPI:1992980759
Name:GUIDICE, THOMAS M (LMFT)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:M
Last Name:GUIDICE
Suffix:
Gender:M
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8816 RIDGE AVE
Mailing Address - Street 2:#18
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19128-2030
Mailing Address - Country:US
Mailing Address - Phone:215-487-3822
Mailing Address - Fax:
Practice Address - Street 1:1415 SOUTHWIND WAY
Practice Address - Street 2:
Practice Address - City:DRESHER
Practice Address - State:PA
Practice Address - Zip Code:19025-1025
Practice Address - Country:US
Practice Address - Phone:215-487-3822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2007-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000541106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist