Provider Demographics
NPI:1386187797
Name:THOMPSON, MONICA (LMSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:MONICA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:203 W 117TH ST
Mailing Address - Street 2:3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10026-2108
Mailing Address - Country:US
Mailing Address - Phone:917-543-8684
Mailing Address - Fax:
Practice Address - Street 1:203 W 117TH ST
Practice Address - Street 2:3E
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10026-2108
Practice Address - Country:US
Practice Address - Phone:917-543-8684
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-02
Last Update Date:2016-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090411104100000X
NY0849821041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker