Provider Demographics
NPI:1023229234
Name:THOMPSON, PAUL ELDEN (MA)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:ELDEN
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 1:129 GERTRUDE ST
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13203-2417
Mailing Address - Country:US
Mailing Address - Phone:315-278-1113
Mailing Address - Fax:
Practice Address - Street 1:405 OAK ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13203-2938
Practice Address - Country:US
Practice Address - Phone:315-278-1113
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-28
Last Update Date:2013-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000641-1106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist