Provider Demographics
NPI:1538272349
Name:THOMPSON, MELISSA M (LCSWR)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:M
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 96
Mailing Address - Street 2:
Mailing Address - City:ESOPUS
Mailing Address - State:NY
Mailing Address - Zip Code:12429-0096
Mailing Address - Country:US
Mailing Address - Phone:845-594-4650
Mailing Address - Fax:845-384-6015
Practice Address - Street 1:20 MILTON AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND
Practice Address - State:NY
Practice Address - Zip Code:12528-1415
Practice Address - Country:US
Practice Address - Phone:845-594-4650
Practice Address - Fax:845-384-6015
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-16
Last Update Date:2016-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYP065165-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033150OtherBEACON HEALTH STRAT
796691000OtherMAGELLAN
7095706OtherAETNA
2190753OtherCIGNA BEH HEALTH
NY390969OtherMVP
NY390969OtherMVP
7095706OtherAETNA