Provider Demographics
NPI:1710044854
Name:THOMPSON, VIRGINIA (CSW)
Entity Type:Individual
Prefix:MS
First Name:VIRGINIA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 BRIGANTINE DR
Mailing Address - Street 2:
Mailing Address - City:SOUTHOLD
Mailing Address - State:NY
Mailing Address - Zip Code:11971-4024
Mailing Address - Country:US
Mailing Address - Phone:631-298-7173
Mailing Address - Fax:631-765-4639
Practice Address - Street 1:1550 BRIGANTINE DR
Practice Address - Street 2:
Practice Address - City:SOUTHOLD
Practice Address - State:NY
Practice Address - Zip Code:11971-4024
Practice Address - Country:US
Practice Address - Phone:631-298-7173
Practice Address - Fax:631-765-4639
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR037495-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical