Provider Demographics
NPI:1518099753
Name:THOMPSON, PETER W III (LCSW)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:W
Last Name:THOMPSON
Suffix:III
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 1:3109 E WHITMORE AVE
Mailing Address - Street 2:
Mailing Address - City:CERES
Mailing Address - State:CA
Mailing Address - Zip Code:95307-2906
Mailing Address - Country:US
Mailing Address - Phone:209-541-2496
Mailing Address - Fax:209-985-6448
Practice Address - Street 1:3109 WHITMORE AVE
Practice Address - Street 2:
Practice Address - City:CERES
Practice Address - State:CA
Practice Address - Zip Code:95307-9415
Practice Address - Country:US
Practice Address - Phone:209-541-2496
Practice Address - Fax:209-985-6448
Is Sole Proprietor?:No
Enumeration Date:2007-03-12
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS167131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS 16713OtherLCSW