Individual
BORIS THOMAS
Active
Individual
BORIS THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD, LCSW
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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