Provider Demographics
NPI:1730435363
Name:ROSA E.THOMPSON, LCSW, A PROFESSIONAL LLC
Entity type:Organization
Organization Name:ROSA E.THOMPSON, LCSW, A PROFESSIONAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROSA
Authorized Official - Middle Name:ESMERALDA
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:512-581-4337
Mailing Address - Street 1:111 N HASLER BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:BASTROP
Mailing Address - State:TX
Mailing Address - Zip Code:78602-3984
Mailing Address - Country:US
Mailing Address - Phone:512-581-4337
Mailing Address - Fax:512-581-4360
Practice Address - Street 1:111 N HASLER BLVD STE 209
Practice Address - Street 2:
Practice Address - City:BASTROP
Practice Address - State:TX
Practice Address - Zip Code:78602-3984
Practice Address - Country:US
Practice Address - Phone:512-581-4337
Practice Address - Fax:512-581-4360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-01
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41005251B00000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1891826061Medicare PIN