Provider Demographics
NPI:1942614532
Name:THOMPSON, JOHN ALBERT (MD, LCSW, CASAC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:ALBERT
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MD, LCSW, CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 W 29TH ST RM 301
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-5551
Mailing Address - Country:US
Mailing Address - Phone:347-746-4332
Mailing Address - Fax:
Practice Address - Street 1:231 W 29TH ST RM 301
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-5551
Practice Address - Country:US
Practice Address - Phone:347-746-4332
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-11
Last Update Date:2020-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY30567101YA0400X
NY0858361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY085836OtherLCSW
NY30567OtherCASAC