MEDICARE: ADRIAN RENE THOMPSON LCSW

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	1041C0700X	Clinical Social Worker	44SC05907700	NJ

General Provider Information

NPI Number	:	1083245971
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADRIAN RENE THOMPSON LCSW

Provider Business Mailing Address
First Line	:	519 WEST ST
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-3522
Country	:	US
Telephone Number	:	856-968-2320
Fax Number	:

Provider Business Practice Location Address
First Line	:	519 WEST ST
Second Line	:
City	:	CAMDEN
State	:	NJ
Zip	:	08103-3522
Country	:	US
Telephone Number	:	856-968-2320
Fax Number	:

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

Provider Enumeration Date	:	01/29/2020
Last Update Date	:	01/30/2020

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