Basic Information
| Provider Information | |||||||||
| NPI: | 1245428127 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THORMAN | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | TYLER | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.S. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 301 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | CHELSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021502807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179127900 | ||||||||
| FaxNumber: | 6178871889 | ||||||||
| Practice Location | |||||||||
| Address1: | 301 BROADWAY | ||||||||
| Address2: | |||||||||
| City: | CHELSEA | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021502807 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6179127900 | ||||||||
| FaxNumber: | 6178871889 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/04/2007 | ||||||||
| LastUpdateDate: | 10/04/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.