MEDICARE: SHERISSE THOMPSON

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	104100000X	Social Worker	110261	NY

General Provider Information

NPI Number	:	1316525934
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERISSE THOMPSON

Provider Business Mailing Address
First Line	:	773 CONCOURSE VLG E APT 1A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-3905
Country	:	US
Telephone Number	:	347-417-6165
Fax Number	:

Provider Business Practice Location Address
First Line	:	773 CONCOURSE VLG E APT 1A
Second Line	:
City	:	BRONX
State	:	NY
Zip	:	10451-3905
Country	:	US
Telephone Number	:	347-417-6165
Fax Number	:

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

Provider Enumeration Date	:	04/02/2021
Last Update Date	:	04/02/2021

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Directions to “ SHERISSE THOMPSON ” Practice Location

Language	Start Address	Practice Location

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