MEDICARE: MADELINE THOMPSON MA LCADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	#37LC00133700	NJ
2	101YM0800X	Mental Health Counselor	#37LC00133700	NJ

General Provider Information

NPI Number	:	1003087800
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MADELINE THOMPSON MA LCADC

Provider Business Mailing Address
First Line	:	933 ROUTE 23
Second Line	:	SUITE #10
City	:	POMPTON PLAINS
State	:	NJ
Zip	:	07444-1047
Country	:	US
Telephone Number	:	973-222-6762
Fax Number	:

Provider Business Practice Location Address
First Line	:	544 TERRACE DR
Second Line	:
City	:	HIGHLAND LAKES
State	:	NJ
Zip	:	07422-1605
Country	:	US
Telephone Number	:	973-764-4872
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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