Provider Demographics
NPI:1669599189
Name:DELISLE, THOMAS JOSEPH (PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:DELISLE
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1262
Mailing Address - Street 2:
Mailing Address - City:HILLSBORO
Mailing Address - State:NH
Mailing Address - Zip Code:03244-1262
Mailing Address - Country:US
Mailing Address - Phone:603-464-6465
Mailing Address - Fax:
Practice Address - Street 1:19 PLEASANT ST.
Practice Address - Street 2:
Practice Address - City:HILLSBORO
Practice Address - State:NH
Practice Address - Zip Code:03244-1262
Practice Address - Country:US
Practice Address - Phone:603-464-6465
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH172103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH20736YMedicare UPIN