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General NPI Number Information
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NPI Number | 1629678198
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Entity Type | Individual
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Provider Name | KELLEY MARIE THOMPSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 10/26/2020
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Last Update Date | 10/26/2020
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Provider Practice Location Address
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Address Line | 1201 SE INDIAN ST
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City | STUART
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State | FL
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Zip | 34997-5688
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Country | US
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Telephone | 772-678-9275
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Fax |
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Provider Business Mailing Address
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Address Line | 1 RIVERVIEW DR
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City | STUART
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State | FL
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Zip | 34996-6314
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Country | US
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Telephone | 918-645-1335
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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 | SW9054
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License Number State | FL
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