Provider Demographics
NPI:1467540930
Name:THOMPSON, BRIAN EARLE (LCSW)
Entity Type:Individual
Prefix:
First Name:BRIAN
Middle Name:EARLE
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 1:16 PRINCESS STREET
Mailing Address - Street 2:
Mailing Address - City:ST. STEPHEN
Mailing Address - State:NEW BRUNSWICK
Mailing Address - Zip Code:E3L 2E8
Mailing Address - Country:CA
Mailing Address - Phone:506-465-9232
Mailing Address - Fax:506-465-8417
Practice Address - Street 1:55 FRANKLIN STREET
Practice Address - Street 2:EASTPORT HEALTH CARE
Practice Address - City:CALAIS
Practice Address - State:ME
Practice Address - Zip Code:04619
Practice Address - Country:US
Practice Address - Phone:207-454-3022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC89201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical