Provider Demographics
NPI:1225129919
Name:THOMPSON, RONALD EDWARD (PSY MA)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:EDWARD
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:PSY MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:576 LIGHTENING RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:VT
Mailing Address - Zip Code:05667-9328
Mailing Address - Country:US
Mailing Address - Phone:802-279-8404
Mailing Address - Fax:
Practice Address - Street 1:19 COURT ST
Practice Address - Street 2:
Practice Address - City:MONTPELIER
Practice Address - State:VT
Practice Address - Zip Code:05602
Practice Address - Country:US
Practice Address - Phone:802-279-8404
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT000682103T00000X, 103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT00049065OtherBCBS OF VT
VT2040066OtherCIGNA
VT1007190Medicaid