Provider Demographics
NPI:1538285911
Name:THOMPSON, JOHN LARRY (LCSW)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:LARRY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 HILLTOP DR
Mailing Address - Street 2:
Mailing Address - City:BRICK
Mailing Address - State:NJ
Mailing Address - Zip Code:08724-1313
Mailing Address - Country:US
Mailing Address - Phone:732-337-9786
Mailing Address - Fax:732-389-0611
Practice Address - Street 1:615 HOPE RD
Practice Address - Street 2:BLDG 1B
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1277
Practice Address - Country:US
Practice Address - Phone:732-389-0697
Practice Address - Fax:732-389-0611
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-21
Last Update Date:2009-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052108001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical