Provider Demographics
NPI:1912023433
Name:THOMPSON, SHELBY ANN (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHELBY
Other - Middle Name:ANN
Other - Last Name:SIBLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:58 QUAIL TRAIL
Mailing Address - Street 2:
Mailing Address - City:BUXTON
Mailing Address - State:ME
Mailing Address - Zip Code:04093
Mailing Address - Country:US
Mailing Address - Phone:207-512-2600
Mailing Address - Fax:207-874-8218
Practice Address - Street 1:175 AUBURN STREET
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04103
Practice Address - Country:US
Practice Address - Phone:207-874-8215
Practice Address - Fax:207-874-8218
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC109241041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431686199Medicaid