Provider Demographics
NPI:1023487550
Name:THOMSEN, MICHEL O (LMSW-CC)
Entity type:Individual
Prefix:MR
First Name:MICHEL
Middle Name:O
Last Name:THOMSEN
Suffix:
Gender:M
Credentials:LMSW-CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 807
Mailing Address - Street 2:
Mailing Address - City:SOUTHWEST HARBOR
Mailing Address - State:ME
Mailing Address - Zip Code:04679-0807
Mailing Address - Country:US
Mailing Address - Phone:207-244-4012
Mailing Address - Fax:
Practice Address - Street 1:1 FERNALD POINT RD
Practice Address - Street 2:
Practice Address - City:SOUTHWEST HARBOR
Practice Address - State:ME
Practice Address - Zip Code:04679-4614
Practice Address - Country:US
Practice Address - Phone:207-244-4012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-15
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC15644104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker