Provider Demographics
NPI:1417197294
Name:THOMPSON, PAULA JANE (LICSW)
Entity Type:Individual
Prefix:MISS
First Name:PAULA
Middle Name:JANE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 SALEM ST
Mailing Address - Street 2:#809
Mailing Address - City:WAKEFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01880-4900
Mailing Address - Country:US
Mailing Address - Phone:781-454-7824
Mailing Address - Fax:
Practice Address - Street 1:20 GOULD ST
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:MA
Practice Address - Zip Code:01867-2927
Practice Address - Country:US
Practice Address - Phone:781-454-7824
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-06
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1149471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA000987001OtherMEDICARE PTAN
MA1100844796Medicaid