Provider Demographics
NPI:1184624132
Name:THOMPSON, MARCELENE CALVERT (LCSW)
Entity type:Individual
Prefix:MS
First Name:MARCELENE
Middle Name:CALVERT
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 N TARRAGONA ST # 6
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-6063
Mailing Address - Country:US
Mailing Address - Phone:850-857-3012
Mailing Address - Fax:850-957-7001
Practice Address - Street 1:24 N TARRAGONA ST # 6
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-6063
Practice Address - Country:US
Practice Address - Phone:850-857-3012
Practice Address - Fax:850-957-7001
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2023-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW43791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ7400OtherBLUE CROSS/BLUE SHIELD