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General NPI Number Information
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NPI Number | 1629280136
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Entity Type | Individual
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Provider Name | VIVIAN STANFORD THOMPSON LCSWR
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Gender | Male
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Dates
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Enumeration Date | 05/04/2007
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Last Update Date | 10/03/2017
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Provider Practice Location Address
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Address Line | 26 COURT STREET SUITE 410 D
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City | BROOKLYN, NY
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State | NY
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Zip | 11242
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Country | US
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Telephone | 646-263-6227
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Fax |
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Provider Business Mailing Address
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Address Line | 26 COURT ST STE 1502
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City | BROOKLYN
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State | NY
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Zip | 11242-1115
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Country | US
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Telephone | 917-204-7852
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Fax | 631-648-8915
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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 | R059610
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License Number State | NY
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