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General NPI Number Information
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NPI Number | 1912023433
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Entity Type | Individual
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Provider Name | SHELBY ANN THOMPSON LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 175 AUBURN STREET
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City | PORTLAND
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State | ME
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Zip | 04103
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Country | US
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Telephone | 207-874-8215
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Fax | 207-874-8218
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Provider Business Mailing Address
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Address Line | 58 QUAIL TRAIL
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City | BUXTON
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State | ME
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Zip | 04093
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Country | US
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Telephone | 207-512-2600
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Fax | 207-874-8218
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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 | LC10924
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License Number State | ME
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