Provider Demographics
NPI:1710189154
Name:THOMPSON, EILEEN Y (MSW, LICSW)
Entity Type:Individual
Prefix:MS
First Name:EILEEN
Middle Name:Y
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 MUZZEY ST
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-5257
Mailing Address - Country:US
Mailing Address - Phone:781-248-9681
Mailing Address - Fax:
Practice Address - Street 1:15 MUZZEY ST
Practice Address - Street 2:1ST FLOOR
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-5257
Practice Address - Country:US
Practice Address - Phone:781-248-9681
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10197851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical