Healthcare Provider Details

I. General information

NPI: 1538272349
Provider Name (Legal Business Name): MELISSA M THOMPSON LCSWR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 12/03/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 MILTON AVE
HIGHLAND NY
12528-1415
US

IV. Provider business mailing address

PO BOX 96
ESOPUS NY
12429-0096
US

V. Phone/Fax

Practice location:
  • Phone: 845-594-4650
  • Fax: 845-384-6015
Mailing address:
  • Phone: 845-594-4650
  • Fax: 845-384-6015

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberP065165-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: