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NPI Code Detail

MEDICARE: MRS. DARLENE MARIE THOMPSON LCSW

MEDICARE: MRS. DARLENE MARIE 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
1101YM0800XMental Health CounselorLCS 19441CA

General Provider Information

NPI Number : 1265551238
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. DARLENE MARIE THOMPSON LCSW
Provider Business Mailing Address
First Line : 421 E MORRIS AVE
Second Line :
City : MODESTO
State : CA
Zip : 95354-0437
Country : US
Telephone Number : 209-558-7494
Fax Number : 209-558-8079
Provider Business Practice Location Address
First Line : 421 E MORRIS AVE
Second Line :
City : MODESTO
State : CA
Zip : 95354-0437
Country : US
Telephone Number : 209-558-7494
Fax Number : 209-558-8079
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/28/2007
Last Update Date : 07/08/2007

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