Individual
THOMAS WILLIAM PEDERSEN
Active
Individual
THOMAS WILLIAM PEDERSEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PSY.D.
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
P0000001751
TN
103TC0700X
Clinical Psychologist
PSY002564
GA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
235954957B
—
GA
01
—
3138951
BCBS W PARADIGM
TN
05
—
3584286
—
TN
01
—
680011023
RR MEDICARE W PARADIGM
TN
Enumeration date
09/19/2006
Last updated
03/20/2014
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