Provider Demographics
NPI:1851567259
Name:THOMPSON, STUART (MA)
Entity Type:Individual
Prefix:
First Name:STUART
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16504-1049
Mailing Address - Country:US
Mailing Address - Phone:814-464-8311
Mailing Address - Fax:814-453-4757
Practice Address - Street 1:16332 CONNEAUT LAKE RD
Practice Address - Street 2:
Practice Address - City:MEADVILLE
Practice Address - State:PA
Practice Address - Zip Code:16335-3843
Practice Address - Country:US
Practice Address - Phone:814-464-8311
Practice Address - Fax:814-453-4757
Is Sole Proprietor?:No
Enumeration Date:2008-05-06
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health