Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSYCHOLOGIST6705 | MA |
N | 103T00000X | Psychologist | PSYCHOLOGIST6705 | MA |
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSYCHOLOGIST6705 | MA |
N | 103TA0700X | Adult Development & Aging Psychologist | PSYCHOLOGIST6705 | MA |
N | 103TC1900X | Counseling Psychologist | PSYCHOLOGIST6705 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | PSYCHOLOGIST6705 | MA |
N | 103TE1100X | Exercise & Sports Psychologist | PSYCHOLOGIST6705 | MA |
N | 103TF0000X | Family Psychologist | PSYCHOLOGIST6705 | MA |
N | 103TP2701X | Group Psychotherapist | PSYCHOLOGIST6705 | MA |
N | 103TS0200X | School Psychologist | PSYCHOLOGIST6705 | MA |
NPI | 1124186986 |
---|---|
Provider Name | Dr. Thomas Chiodetti |
First Address | Falmouth, MA 02540-2918 |
Second Address | Falmouth, MA 02540-2918 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/12/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
007980 | VALUE OPTIONS (01) | MA |
0525383 | (05) | MA |
198339 | MHN (01) | MA |
W05410 | BCBS (01) | MA |