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General NPI Number Information
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NPI Number | 1538285911
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Entity Type | Individual
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Provider Name | JOHN LARRY THOMPSON LCSW
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Gender | Male
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Dates
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Enumeration Date | 03/21/2007
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Last Update Date | 10/15/2009
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Provider Practice Location Address
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Address Line | 615 HOPE RD BLDG 1B
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City | EATONTOWN
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State | NJ
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Zip | 07724-1277
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Country | US
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Telephone | 732-389-0697
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Fax | 732-389-0611
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Provider Business Mailing Address
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Address Line | 155 HILLTOP DR
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City | BRICK
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State | NJ
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Zip | 08724-1313
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Country | US
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Telephone | 732-337-9786
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Fax | 732-389-0611
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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 | 44SC05210800
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License Number State | NJ
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