Provider Demographics
NPI:1700334620
Name:THOMPSON ROSARIO, GLORIMAR
Entity type:Individual
Prefix:
First Name:GLORIMAR
Middle Name:
Last Name:THOMPSON ROSARIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GLORIMAR
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13 RAMBLER CT
Mailing Address - Street 2:
Mailing Address - City:WILLINGBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:08046-2524
Mailing Address - Country:US
Mailing Address - Phone:609-635-0198
Mailing Address - Fax:
Practice Address - Street 1:13 RAMBLER CT
Practice Address - Street 2:
Practice Address - City:WILLINGBORO
Practice Address - State:NJ
Practice Address - Zip Code:08046-2524
Practice Address - Country:US
Practice Address - Phone:609-635-0198
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2016-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool