Provider Demographics
NPI:1033342993
Name:THOMPSON, LUANN KAY (BSW)
Entity Type:Individual
Prefix:MS
First Name:LUANN
Middle Name:KAY
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:211 CHANDLER ST
Mailing Address - Street 2:APT. 312
Mailing Address - City:CAPE CANAVERAL
Mailing Address - State:FL
Mailing Address - Zip Code:32920-2665
Mailing Address - Country:US
Mailing Address - Phone:321-794-3918
Mailing Address - Fax:321-610-8880
Practice Address - Street 1:1861 S PATRICK DR
Practice Address - Street 2:BOX 166
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4377
Practice Address - Country:US
Practice Address - Phone:321-610-8880
Practice Address - Fax:321-610-8880
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL764145100Medicaid