Healthcare Provider Details

I. General information

NPI: 1780667741
Provider Name (Legal Business Name): SCOTT D THOMPSON LMHC
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/23/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

915 SOUTH ST
FITCHBURG MA
01420-6252
US

IV. Provider business mailing address

72 CARRINGTON LN
UXBRIDGE MA
01569-3215
US

V. Phone/Fax

Practice location:
  • Phone: 978-345-4147
  • Fax: 978-345-1616
Mailing address:
  • Phone: 508-579-1498
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: