Healthcare Provider Details

I. General information

NPI: 1801377817
Provider Name (Legal Business Name): CARLA CATHLINE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 OLD WEST CHESTER PIKE
HAVERTOWN PA
19083-2712
US

IV. Provider business mailing address

128 E WASHINGTON AVE
CLIFTON HEIGHTS PA
19018-2331
US

V. Phone/Fax

Practice location:
  • Phone: 484-454-8700
  • Fax:
Mailing address:
  • Phone: 610-259-7214
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW020059
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: