Provider Demographics
NPI:1013324326
Name:THOMPSON, MARICIA TONI (LMSW)
Entity Type:Individual
Prefix:MISS
First Name:MARICIA
Middle Name:TONI
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 PUTNAM AVE
Mailing Address - Street 2:#3
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11221-4808
Mailing Address - Country:US
Mailing Address - Phone:347-247-6631
Mailing Address - Fax:718-485-5495
Practice Address - Street 1:2901 CAMPUS ROAD
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11210
Practice Address - Country:US
Practice Address - Phone:347-247-6631
Practice Address - Fax:718-485-5495
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2014-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091584104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker