Provider Demographics
NPI:1134540511
Name:MARGARET A THOMSON LCSW
Entity type:Organization
Organization Name:MARGARET A THOMSON LCSW
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PEGGY
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMSON
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:239-949-3199
Mailing Address - Street 1:3451 BONITA BAY BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:BONITA SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:34134-4354
Mailing Address - Country:US
Mailing Address - Phone:239-949-3199
Mailing Address - Fax:239-949-7054
Practice Address - Street 1:3451 BONITA BAY BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:BONITA SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:34134-4354
Practice Address - Country:US
Practice Address - Phone:239-949-3199
Practice Address - Fax:239-949-7054
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-01-02
Last Update Date:2016-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW52251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL008771600Medicaid
FL008771600Medicaid