Provider Demographics
NPI:1760751135
Name:THOMSON, DAVID CARROLL (MA, CAS)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CARROLL
Last Name:THOMSON
Suffix:
Gender:M
Credentials:MA, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:570 RTE. 312 AVE.
Mailing Address - Street 2:
Mailing Address - City:BREWSTER
Mailing Address - State:NY
Mailing Address - Zip Code:10509
Mailing Address - Country:US
Mailing Address - Phone:845-279-3958
Mailing Address - Fax:845-279-7634
Practice Address - Street 1:570 ROUTE 312
Practice Address - Street 2:
Practice Address - City:BREWSTER
Practice Address - State:NY
Practice Address - Zip Code:10509-3711
Practice Address - Country:US
Practice Address - Phone:845-279-3958
Practice Address - Fax:845-279-7634
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool