Provider Demographics
NPI:1790119105
Name:THOMPSON, KRISTINA (LCSW)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2552 CENTERGATE DR
Mailing Address - Street 2:APT 202
Mailing Address - City:MIRAMAR
Mailing Address - State:FL
Mailing Address - Zip Code:33025-7251
Mailing Address - Country:US
Mailing Address - Phone:305-333-6669
Mailing Address - Fax:
Practice Address - Street 1:17501 BISCAYNE BLVD
Practice Address - Street 2:450
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33160-4802
Practice Address - Country:US
Practice Address - Phone:305-333-6669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-21
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW114671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical