Individual provider Active NPI

Andrew Todd Thomas, PSY.D.

  • Mental Health Counselor
  • Montclair, NJ
National Provider Identifier
1972658409
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Mental Health CounselorTaxonomy code 101YM0800X
License
SI03635 Issued in NJ
Practice address
183 Inwood Ave
Montclair, NJ 07043-1908
Phone
(973) 783-6977
Fax
(973) 783-6597
NPI assigned
Jan 24, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Mental Health Counselor 101YM0800X SI03635 NJ Primary

Addresses

Primary practice location

183 Inwood Ave
Montclair, NJ 07043-1908

Mailing address

183 Inwood Ave
Montclair, NJ 07043-1908
Phone (973) 783-6977

Other identifiers 1

IdentifierTypeStateIssuer
7821409MedicaidNJ

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NJ
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

Enrollment IDStateProvider typePAC IDDetails
I20100201000646 NJ Practitioner - Clinical Psychologist 8426191362 Practice locations: Montclair, NJ

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1995
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

49 Park St
Montclair, NJ 07042-3439
Phone (973) 342-6185

55 Park St
Montclair, NJ 07042-3439

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
SI03635NJMDMental Health Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Montclair Counseling Center Past Accepting new patients

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1169596800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1972658409",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "183 INWOOD AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070431908",
            "telephone_number": "973-783-6977",
            "fax_number": "973-783-6597"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "183 INWOOD AVE",
            "city": "MONTCLAIR",
            "state": "NJ",
            "postal_code": "070431908",
            "telephone_number": "973-783-6977",
            "fax_number": "973-783-6597"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMAS",
        "first_name": "ANDREW",
        "middle_name": "TODD",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-24",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "NJ",
            "license": "SI03635",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7821409",
            "state": "NJ"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Montclair, NJ

Sources for this page

Verify at the official NPI Registry.