MEDICARE: PAUL ELDEN THOMPSON M.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	000641-1	NY

General Provider Information

NPI Number	:	1023229234
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL ELDEN THOMPSON M.A.

Provider Business Mailing Address
First Line	:	129 GERTRUDE ST
Second Line	:
City	:	SYRACUSE
State	:	NY
Zip	:	13203-2417
Country	:	US
Telephone Number	:	315-278-1113
Fax Number	:

Provider Business Practice Location Address
First Line	:	405 OAK ST
Second Line	:	2ND FLOOR
City	:	SYRACUSE
State	:	NY
Zip	:	13203-2938
Country	:	US
Telephone Number	:	315-278-1113
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/28/2007
Last Update Date	:	12/20/2013

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