Provider Demographics
NPI:1518003961
Name:THOMPSON, CLAUDETTE KERRY-ANN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:CLAUDETTE
Middle Name:KERRY-ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17810 WEXFORD TER
Mailing Address - Street 2:#4J
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11432-3050
Mailing Address - Country:US
Mailing Address - Phone:718-291-0548
Mailing Address - Fax:
Practice Address - Street 1:11515 SUTPHIN BLVD
Practice Address - Street 2:
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11434-1020
Practice Address - Country:US
Practice Address - Phone:718-659-4000
Practice Address - Fax:718-659-1405
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR060439-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical