Provider Demographics
NPI:1154805695
Name:THOMPSON, ANNE MARIE (LICSW)
Entity type:Individual
Prefix:
First Name:ANNE MARIE
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:ANNE MARIE
Other - Middle Name:
Other - Last Name:EVRIRIADES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LICSW
Mailing Address - Street 1:160 DERBY STREET
Mailing Address - Street 2:#338
Mailing Address - City:HINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02043
Mailing Address - Country:US
Mailing Address - Phone:617-429-5014
Mailing Address - Fax:781-987-7277
Practice Address - Street 1:160 DERBY STREET
Practice Address - Street 2:#338
Practice Address - City:HINGHAM
Practice Address - State:MA
Practice Address - Zip Code:02043
Practice Address - Country:US
Practice Address - Phone:617-429-5014
Practice Address - Fax:781-987-7277
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-20
Last Update Date:2019-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1187711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA118771OtherLICENSE