| Doctor Name: | THOMAS J CORMICAN |
| NPI Number: | 1003879206 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LICSW, LADC 1 |
| License Number: | 2274 |
| Business Practice Address: | 33 Gregory St Middleton, MA - 019493848 |
| Business Phone Number: | 6038175075 |
| Business Fax Number: | |
| Mailing Address: | 20 Ledgeview Dr, GONIC |
| State: | NH |
| Postal Code: | 038395619 |
| Phone Number: | 6038175075 |
| Fax Number: | |
| NPI Enumeration Date: | 04/10/2006 |
| NPI Last Update Date: | 05/12/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 2274 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | MA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |