Provider Demographics
NPI:1710014535
Name:TAYLOR, THOMAS SCOTT (LCSWR, PHD)
Entity type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:SCOTT
Last Name:TAYLOR
Suffix:
Gender:M
Credentials:LCSWR, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 HUDSON ST APT 213
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10014-3647
Mailing Address - Country:US
Mailing Address - Phone:917-886-6399
Mailing Address - Fax:212-924-6135
Practice Address - Street 1:2504 BROADWAY
Practice Address - Street 2:C/O ADVENT LUTHERAN CHURCH
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6949
Practice Address - Country:US
Practice Address - Phone:917-886-6399
Practice Address - Fax:212-924-6135
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY074695R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY074695ROtherNEW YORK STATE LCSWR LICENSE #
NYN8B952Medicare ID - Type UnspecifiedPROVIDER # OR LEGACY #