Provider Demographics
NPI:1902486368
Name:THOMPSON, ALEX SHAQUILLE (LCSW, MSW)
Entity Type:Individual
Prefix:MR
First Name:ALEX
Middle Name:SHAQUILLE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCSW, MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:18-20 LACKAWANNA PLZ STE 200
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-3642
Mailing Address - Country:US
Mailing Address - Phone:862-801-0974
Mailing Address - Fax:973-860-6164
Practice Address - Street 1:18-20 LACKAWANNA PLZ STE 200
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-3642
Practice Address - Country:US
Practice Address - Phone:862-801-0974
Practice Address - Fax:973-860-6164
Is Sole Proprietor?:No
Enumeration Date:2021-04-10
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC061081001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical