Thomas Ray Theriault, PSY.D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

05432 Issued in MD

Practice address

222 Courthouse CT
2D
Towson, MD 21204-1828

Phone

(443) 692-7362

NPI assigned

Jun 7, 2014

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in MD

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Lucid Psychiatric Practice LLCGroup PAC ID 5092087445, 6 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lucid Psychiatric Practice LLC

  • Psychiatric/Mental Health Nurse Practitioner
  • Towson, MD
  • NPI 1235660457
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1402099200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1402099200000",
    "number": "1942613997",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3328 GARRISON CIR",
            "city": "ABINGDON",
            "state": "MD",
            "postal_code": "210092546",
            "telephone_number": "443-504-5631"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "222 COURTHOUSE CT",
            "address_2": "2D",
            "city": "TOWSON",
            "state": "MD",
            "postal_code": "212041828",
            "telephone_number": "443-692-7362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THERIAULT",
        "first_name": "THOMAS",
        "middle_name": "RAY",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-06-07",
        "last_updated": "2014-06-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "MD",
            "license": "05432",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Therafit Enterprises, Inc.
• Theramove & Diagnostics, LLC
• Therapeutic Solutions, LLC
• Therapy & Learning Center, LLC
• Theresa Lummino
• Kathleen Denise Thomakos, OTR/L
• Thomas Llewellyn, DDS, Assoc. PA
• Thomas Point Capital, LLC
• Candice Tisdale Thomas, LCSWC ACSW
• Dara Thomas

• Psychologist in Towson, MD
• Providers in Towson, MD by specialty
• Psychologist in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 7, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.