MEDICARE: KAREN VERNEN-THOMPSON LICSW

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	113399	MA

General Provider Information

NPI Number	:	1982778023
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAREN VERNEN-THOMPSON LICSW

Provider Business Mailing Address
First Line	:	1238 ROUTE 28A
Second Line	:
City	:	NORTH FALMOUTH
State	:	MA
Zip	:	02556-1016
Country	:	US
Telephone Number	:	774-269-9385
Fax Number	:

Provider Business Practice Location Address
First Line	:	70 KILBURN ST
Second Line	:
City	:	NEW BEDFORD
State	:	MA
Zip	:	02740-7321
Country	:	US
Telephone Number	:	508-984-1697
Fax Number	:	508-984-1694

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

Provider Enumeration Date	:	11/20/2006
Last Update Date	:	08/09/2013

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