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General NPI Number Information
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NPI Number | 1205136876
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Entity Type | Individual
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Provider Name | HEATHER THOMPSON PHD, LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/28/2010
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Last Update Date | 12/10/2024
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Provider Practice Location Address
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Address Line | 1430 NW 47TH AVE
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City | COCONUT CREEK
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State | FL
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Zip | 33063-3947
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Country | US
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Telephone | 786-841-2553
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Fax |
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Provider Business Mailing Address
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Address Line | 1677 MAHAN CENTER BLVD
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City | TALLAHASSEE
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State | FL
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Zip | 32308-5454
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW11424
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License Number State | FL
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