Provider Demographics
NPI:1356858617
Name:THOMPSON, LORI (LMHC; NCC)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMHC; NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1069 MAIN ST STE 193
Mailing Address - Street 2:
Mailing Address - City:HOLBROOK
Mailing Address - State:NY
Mailing Address - Zip Code:11741-1618
Mailing Address - Country:US
Mailing Address - Phone:631-619-3339
Mailing Address - Fax:
Practice Address - Street 1:6 ROOSEVELT AVE
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSON STATION
Practice Address - State:NY
Practice Address - Zip Code:11776-3364
Practice Address - Country:US
Practice Address - Phone:631-619-3339
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-08
Last Update Date:2018-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008418101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health