Provider Demographics
NPI:1144668898
Name:THOMPSON, DEREK JAMES
Entity type:Individual
Prefix:MR
First Name:DEREK
Middle Name:JAMES
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:228 ARLINGTON ST
Mailing Address - Street 2:
Mailing Address - City:DRACUT
Mailing Address - State:MA
Mailing Address - Zip Code:01826-4017
Mailing Address - Country:US
Mailing Address - Phone:339-223-8463
Mailing Address - Fax:
Practice Address - Street 1:35 JOHN ST
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:MA
Practice Address - Zip Code:01852-1101
Practice Address - Country:US
Practice Address - Phone:781-388-6436
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA042316924Medicaid