Provider Demographics
NPI:1629120423
Name:THOMPSON, CHERYL L (SW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:SW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2611 EUBANK BLVD NE BLDG F
Mailing Address - Street 2:SIERRA ALTERNATIVE
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-1312
Mailing Address - Country:US
Mailing Address - Phone:505-296-6708
Mailing Address - Fax:
Practice Address - Street 1:2611 EUBANK BLVD NE BLDG F
Practice Address - Street 2:SIERRA ALTERNATIVE
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87112-1312
Practice Address - Country:US
Practice Address - Phone:505-296-6708
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI 32901041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM72773Medicaid