Healthcare Provider Details

I. General information

NPI: 1215844683
Provider Name (Legal Business Name): SHELBY NICOLE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2026
Last Update Date: 08/24/2026
Certification Date: 08/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

273 WALL ST STE 1M
KINGSTON NY
12401-3817
US

IV. Provider business mailing address

24 ADAMS ST APT 1
KINGSTON NY
12401-6099
US

V. Phone/Fax

Practice location:
  • Phone: 845-481-0481
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: