Provider Demographics
NPI:1124418959
Name:THOMPSON, WILLIAM J (MSW LSW)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MSW LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LEOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17540-1753
Mailing Address - Country:US
Mailing Address - Phone:717-556-0149
Mailing Address - Fax:717-656-2434
Practice Address - Street 1:219 W MAIN ST
Practice Address - Street 2:
Practice Address - City:LEOLA
Practice Address - State:PA
Practice Address - Zip Code:17540-1753
Practice Address - Country:US
Practice Address - Phone:717-556-0149
Practice Address - Fax:717-656-2434
Is Sole Proprietor?:No
Enumeration Date:2015-02-02
Last Update Date:2015-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW0011751E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker