Individual
DR. THOMAS JOHN DETERS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Contact information
Practice address
1753 MASSACHUSETTS AVE, CAMBRIDGE, MA 02140-2231
(617) 661-7516
(617) 661-7516
Mailing address
61 GARFIELD ST APT 16, CAMBRIDGE, MA 02138-1865
(617) 661-7516
(617) 661-7516
Taxonomy
Speciality
Code
Description
License number
State
103G00000X
Clinical Neuropsychologist
3637
MA
103T00000X
Psychologist
353
NH
103T00000X
Psychologist
3637
MA
103TC0700X
Clinical Psychologist
3637
MA
103TF0200X
Forensic Psychologist
Primary
3637
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
W03667
BCBS
—
Enumeration date
12/15/2005
Last updated
09/11/2025
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