Healthcare Provider Details

I. General information

NPI: 1598091217
Provider Name (Legal Business Name): PATRICK BARDON THOMPSON MSW, LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/30/2009
Last Update Date: 10/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

825 VAN NESS AVE SUITE 503
SAN FRANCISCO CA
94109-7891
US

IV. Provider business mailing address

4065 19TH ST
SAN FRANCISCO CA
94114-2561
US

V. Phone/Fax

Practice location:
  • Phone: 415-775-7766
  • Fax: 415-775-7730
Mailing address:
  • Phone: 415-672-8099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS26055
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC303344
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: