Provider Demographics
NPI:1003871054
Name:THOMPSON, KATHLEEN O (LICSW)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:O
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 POTTER AVE
Mailing Address - Street 2:
Mailing Address - City:ST ALBANS
Mailing Address - State:VT
Mailing Address - Zip Code:05478-5120
Mailing Address - Country:US
Mailing Address - Phone:802-527-7145
Mailing Address - Fax:
Practice Address - Street 1:107 FISHER POND RD
Practice Address - Street 2:
Practice Address - City:ST ALBANS
Practice Address - State:VT
Practice Address - Zip Code:05478-6286
Practice Address - Country:US
Practice Address - Phone:802-524-6555
Practice Address - Fax:802-524-6562
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT089-00001591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1011979Medicaid
VT368363OtherMHN
VT29869OtherBCBS
VT2052636OtherCIGNA
VT1011979Medicaid