Provider Demographics
NPI:1548744766
Name:THOMPSON, TAMMY (LICSW)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:
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 1:500 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HYANNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02601-5444
Mailing Address - Country:US
Mailing Address - Phone:508-760-0314
Mailing Address - Fax:508-790-3006
Practice Address - Street 1:500 MAIN ST
Practice Address - Street 2:
Practice Address - City:HYANNIS
Practice Address - State:MA
Practice Address - Zip Code:02601-5444
Practice Address - Country:US
Practice Address - Phone:508-760-0314
Practice Address - Fax:508-790-3006
Is Sole Proprietor?:No
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1032144104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker