MEDICARE: SUSAN 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	0904006333	VA

General Provider Information

NPI Number	:	1265446959
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN THOMPSON LCSW

Provider Business Mailing Address
First Line	:	5029 CORPORATE WOODS DR
Second Line	:	SUITE 250
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4376
Country	:	US
Telephone Number	:	757-473-3770
Fax Number	:	757-473-3768

Provider Business Practice Location Address
First Line	:	5029 CORPORATE WOODS DR
Second Line	:	SUITE 250
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23462-4376
Country	:	US
Telephone Number	:	757-473-3770
Fax Number	:	757-473-3768

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

Provider Enumeration Date	:	07/28/2006
Last Update Date	:	07/08/2007

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Directions to “ SUSAN THOMPSON LCSW” Practice Location

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