Individual
BORIS THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, LCSW
Contact information
Practice address
303 5TH AVE STE 602, NEW YORK, NY 10016-6601
(917) 224-3855
Mailing address
603 W 115TH ST # 253, NEW YORK, NY 10025-7722
(312) 279-7575
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
081412-1
NY
1041C0700X
Clinical Social Worker
149-010219
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01632700
BLUECROSSBLUESHIELD NO.
IL
01
—
149-01029
IL LCSW LIC NO.
IL
01
—
480484
VALUE OPTIONS PROVIDER NO
IL
01
—
R-081412-1
NY LCSW
NY
Enumeration date
11/09/2006
Last updated
10/25/2015
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