Healthcare Provider Details

I. General information

NPI: 1295933489
Provider Name (Legal Business Name): NOLAN M THOMPSON LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/10/2007
Last Update Date: 03/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

755 ROOSEVELT TRL # 3B
WINDHAM ME
04062-5341
US

IV. Provider business mailing address

2 VILLA RD
WESTBROOK ME
04092-3628
US

V. Phone/Fax

Practice location:
  • Phone: 207-415-9326
  • Fax: 207-899-4951
Mailing address:
  • Phone: 207-415-9326
  • Fax: 207-899-4951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC3625
License Number StateME

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier219870000
Identifier TypeMEDICAID
Identifier StateME
Identifier Issuer

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: