Provider Demographics
NPI:1184974560
Name:THOMPSON, MARTIN PAUL (LCSW)
Entity type:Individual
Prefix:MR
First Name:MARTIN
Middle Name:PAUL
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15945 84TH AVE N
Mailing Address - Street 2:
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33418-1872
Mailing Address - Country:US
Mailing Address - Phone:609-234-7214
Mailing Address - Fax:
Practice Address - Street 1:15945 84TH AVE N
Practice Address - Street 2:
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33418-1872
Practice Address - Country:US
Practice Address - Phone:609-234-7214
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 106301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical