Healthcare Provider Details

I. General information

NPI: 1164969846
Provider Name (Legal Business Name): SEON F THOMPSON LMSW, BCD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2017
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 851 BOX 340
FPO AE
09834-0004
US

IV. Provider business mailing address

PSC 851 BOX 340
FPO AE
09834-0004
US

V. Phone/Fax

Practice location:
  • Phone: 973-341-4689
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number6801100570
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number6801105043
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: