Thaddeus Ronald Mogilnicki, ED.D.
Individual provider Active NPI Clinical Psychologist · Plymouth, MA
NPI 1992874978 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1992874978
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- 912 (MA)
- Practice address
- 323 Court St
Plymouth, MA 02360-4322 - Phone
- (508) 747-2718
- Fax
- (508) 747-5209
- NPI assigned
- Nov 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 912 | MA | Yes |
Addresses
Primary practice location
323 Court St
Plymouth, MA 02360-4322
Mailing address
12 Shawme Rd
Sandwich, MA 02563-2336
Phone (508) 888-4721
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 468604 | Other | MA | TUFTS |
| 1895532 | Medicaid | MA | |
| W01662 | Other | MA | BC BS INDEMNITY |
| 2168630 | Other | MA | CIGNA GROUP |
| 213380 | Other | MA | NEIGHBORHOOD HEALTH GROUP |
| 311299 | Other | MA | MHN |
| 000000030825 | Other | MA | BOSTON MEDICAL HEALTH NET |
| 497004 | Other | MA | VAUE OPTIONS |
| M19000 | Other | MA | BC BS HMO GROUP |
Other providers in Plymouth, MA
- Judith E Mitchell
- Justine Lee Mitchell
- Toni R Mitchell
- MJH Nutrition
- Nahid Modarres
- Omar Mohamed Mohamed
- Rachael Mohan
- Philip Joseph Molloy IV
- Luis Augusto Molmenti
- Elizabeth Anne Monaghan
All providers in Plymouth, MA · Clinical Psychologist in Massachusetts
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.