Provider Demographics
NPI:1659137750
Name:THOMPSON, DERYCK ANTHONY (MS)
Entity Type:Individual
Prefix:MR
First Name:DERYCK
Middle Name:ANTHONY
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:680 DAVISON RD
Mailing Address - Street 2:
Mailing Address - City:LOCKPORT
Mailing Address - State:NY
Mailing Address - Zip Code:14094-5338
Mailing Address - Country:US
Mailing Address - Phone:716-302-3200
Mailing Address - Fax:
Practice Address - Street 1:680 DAVISON RD
Practice Address - Street 2:
Practice Address - City:LOCKPORT
Practice Address - State:NY
Practice Address - Zip Code:14094-5338
Practice Address - Country:US
Practice Address - Phone:716-302-3200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-26
Last Update Date:2024-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health