Provider Demographics
NPI:1578831574
Name:THOMPSON, LADAN MIREMADI
Entity Type:Individual
Prefix:
First Name:LADAN
Middle Name:MIREMADI
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:43 DARTMOUTH STREET
Mailing Address - Street 2:
Mailing Address - City:MALDEN
Mailing Address - State:MA
Mailing Address - Zip Code:02418
Mailing Address - Country:US
Mailing Address - Phone:781-306-4820
Mailing Address - Fax:781-393-6554
Practice Address - Street 1:282 CENTRAL ST
Practice Address - Street 2:
Practice Address - City:ACTON
Practice Address - State:MA
Practice Address - Zip Code:01720-4790
Practice Address - Country:US
Practice Address - Phone:978-472-0224
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-05
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1303414Medicaid