Provider Demographics
NPI:1578665378
Name:THOMSON, PATRICIA M (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:M
Last Name:THOMSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:171 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:DELHI
Mailing Address - State:NY
Mailing Address - Zip Code:13753-1044
Mailing Address - Country:US
Mailing Address - Phone:607-746-3729
Mailing Address - Fax:
Practice Address - Street 1:171 MAIN ST
Practice Address - Street 2:
Practice Address - City:DELHI
Practice Address - State:NY
Practice Address - Zip Code:13753-1044
Practice Address - Country:US
Practice Address - Phone:607-746-3729
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-02
Last Update Date:2011-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR029200-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN67991Medicare ID - Type UnspecifiedPROVIDER NUMBER