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DR. THOMAS JOHN DETERS PHD

Clinical Neuropsychologist

Cambridge, Massachusetts

Provider NPI: 1851376578

Provider Information:
DR. THOMAS JOHN DETERS PHD
Gender: M
Sole Proprietor


Practice Location:
1753 MASSACHUSETTS AVE  CAMBRIDGE, MA 02140 US
Tel: 617-661-7516  Fax: 617-661-7516

Business Mailing Address:
61 GARFIELD ST APT 16  CAMBRIDGE, MA 02138 US
Tel: 617-661-7516  Fax: 617-661-7516

Entity Type: Individual

Taxonomy:

PrimaryCodeCategory/DescriptionStateLicense Number
X103G00000XBehavioral Health & Social Service Providers
Clinical Neuropsychologist
MA3637
X103T00000XBehavioral Health & Social Service Providers
Psychologist
NH353
X103T00000XBehavioral Health & Social Service Providers
Psychologist
MA3637
X103TC0700XBehavioral Health & Social Service Providers
Psychologist
MA3637
X103TF0200XBehavioral Health & Social Service Providers
Psychologist
MA3637

Other Provider Identifiers:

IssuerNumberStateType
BCBSW0366701
Code values:
01, Other | 02, Medicare Upin | 04, Medicare Id-Type Unspecified
05, Medicaid | 06, Medicare Oscar/Certification | 07, Medicare NSC | 08, Medicare Pin







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