Provider Demographics
NPI:1760424675
Name:THOMPSON, MARY WELTE (EDD)
Entity Type:Individual
Prefix:DR
First Name:MARY
Middle Name:WELTE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 HOUSTON RD
Mailing Address - Street 2:
Mailing Address - City:AMBLER
Mailing Address - State:PA
Mailing Address - Zip Code:19002-3440
Mailing Address - Country:US
Mailing Address - Phone:215-628-9656
Mailing Address - Fax:
Practice Address - Street 1:400 HOUSTON RD
Practice Address - Street 2:
Practice Address - City:AMBLER
Practice Address - State:PA
Practice Address - Zip Code:19002-3440
Practice Address - Country:US
Practice Address - Phone:215-628-9656
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS000299-L103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PATH52014OtherBLUE SHIELD
PA052014Medicare ID - Type Unspecified