Provider Demographics
NPI:1093949034
Name:THOMPSON, MARTINA (BA)
Entity Type:Individual
Prefix:
First Name:MARTINA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2038 CARMEL RD
Mailing Address - Street 2:
Mailing Address - City:MILLVILLE
Mailing Address - State:NJ
Mailing Address - Zip Code:08332-9754
Mailing Address - Country:US
Mailing Address - Phone:856-825-6810
Mailing Address - Fax:856-327-3320
Practice Address - Street 1:333 IRVING AVE
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:NJ
Practice Address - Zip Code:08302-2123
Practice Address - Country:US
Practice Address - Phone:856-455-5555
Practice Address - Fax:856-455-5405
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-05
Last Update Date:2009-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1447337134Medicaid