Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 2274 | MA |
N | 1041C0700X | Clinical Social Worker | 115174 | MA |
Y | 1041C0700X | Clinical Social Worker | 1745 | NH |
NPI | 1003879206 |
---|---|
Provider Name | Thomas J Cormican |
First Address | Gonic, NH 03839-5619 |
Second Address | Rochester, NH 03839-5619 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2006 |
Last Update Date | 08/12/2020 |