Provider Demographics
NPI:1174601025
Name:PLUNKETT, THOMAS R (MSW)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:R
Last Name:PLUNKETT
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01267-2633
Mailing Address - Country:US
Mailing Address - Phone:413-822-2329
Mailing Address - Fax:413-304-3413
Practice Address - Street 1:1211 MAIN ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSTOWN
Practice Address - State:MA
Practice Address - Zip Code:01267-2633
Practice Address - Country:US
Practice Address - Phone:413-822-2329
Practice Address - Fax:413-304-3413
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA104835101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA15475OtherHEALTH NEW ENGLAND
MA101537OtherMBC
MAP03097OtherBLUE CROSS/BLUE SHIELD
MA101537OtherMBC