Provider Demographics
NPI:1144563131
Name:MAGNUS, THOMAS B (DBA: BAM)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:B
Last Name:MAGNUS
Suffix:
Gender:M
Credentials:DBA: BAM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MAPLE AVE STE 3E
Mailing Address - Street 2:
Mailing Address - City:RED BANK
Mailing Address - State:NJ
Mailing Address - Zip Code:07701-1729
Mailing Address - Country:US
Mailing Address - Phone:732-539-8911
Mailing Address - Fax:
Practice Address - Street 1:130 MAPLE AVE STE 3E
Practice Address - Street 2:
Practice Address - City:RED BANK
Practice Address - State:NJ
Practice Address - Zip Code:07701-1729
Practice Address - Country:US
Practice Address - Phone:732-539-8911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-28
Last Update Date:2024-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00441900101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional