Provider Demographics
NPI:1265647648
Name:THOMPSON, ROBERT EDGAR (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EDGAR
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3044 BRECKENRIDGE LN
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40220-2192
Mailing Address - Country:US
Mailing Address - Phone:502-493-8002
Mailing Address - Fax:
Practice Address - Street 1:3044 BRECKENRIDGE LN
Practice Address - Street 2:SUITE 204
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40220-2192
Practice Address - Country:US
Practice Address - Phone:502-493-8002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY7731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical