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General NPI Number Information
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NPI Number | 1811926439
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Entity Type | Individual
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Provider Name | ERIK CONVERSE THOMPSON MA
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Gender | Male
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Dates
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Enumeration Date | 07/03/2006
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Last Update Date | 02/13/2008
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Provider Practice Location Address
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Address Line | 1 MILL ST BOX B10
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City | BURLINGTON
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State | VT
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Zip | 05401-1530
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Country | US
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Telephone | 802-658-4800
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Fax |
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Provider Business Mailing Address
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Address Line | 1 MILL ST BOX B10
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City | BURLINGTON
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State | VT
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Zip | 05401-1530
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Country | US
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Telephone | 802-658-4800
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 047 0000 619
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License Number State | VT
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