Provider Demographics
NPI:1548335391
Name:DENNIS R. THORNTON, PHD
Entity type:Organization
Organization Name:DENNIS R. THORNTON, PHD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:ROBERT
Authorized Official - Last Name:THORNTON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:914-769-3879
Mailing Address - Street 1:24 SOUTH VIEW STREET
Mailing Address - Street 2:
Mailing Address - City:PLEASANTVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:10570
Mailing Address - Country:US
Mailing Address - Phone:914-769-3879
Mailing Address - Fax:
Practice Address - Street 1:24 SOUTH VIEW STREET
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NY
Practice Address - Zip Code:10570
Practice Address - Country:US
Practice Address - Phone:914-769-3879
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008632-2103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYR28169Medicare UPIN
NYV83131Medicare ID - Type UnspecifiedPSYCHOLOGIST