MEDICARE: LEAH F 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	221700000X	Art Therapist	16LP00000100	NJ

General Provider Information

NPI Number	:	1609629302
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LEAH F THOMPSON

Provider Business Mailing Address
First Line	:	412 PROSPECT ST APT 4
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-6064
Country	:	US
Telephone Number	:	732-890-0255
Fax Number	:

Provider Business Practice Location Address
First Line	:	412 PROSPECT ST APT 4
Second Line	:
City	:	LONG BRANCH
State	:	NJ
Zip	:	07740-6064
Country	:	US
Telephone Number	:	732-890-0255
Fax Number	:

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

Provider Enumeration Date	:	04/10/2024
Last Update Date	:	04/10/2024

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Directions to “ LEAH F THOMPSON ” Practice Location

Language	Start Address	Practice Location

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