MEDICARE: MS. JOSETTE THOMPSON

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1780223610
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. JOSETTE THOMPSON

Provider Business Mailing Address
First Line	:	6 BLOSSOM LANE
Second Line	:
City	:	GLOUCESTER
State	:	MA
Zip	:	01930
Country	:	US
Telephone Number	:	978-290-8389
Fax Number	:

Provider Business Practice Location Address
First Line	:	11 BOSTON ST
Second Line	:
City	:	SALEM
State	:	MA
Zip	:	01970-2103
Country	:	US
Telephone Number	:	978-290-8389
Fax Number	:

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

Provider Enumeration Date	:	12/23/2019
Last Update Date	:	12/23/2019

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Directions to “ MS. JOSETTE THOMPSON ” Practice Location

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