Provider Demographics
NPI:1245442532
Name:THOMPSON, JUDITH N (MENTAL HEALTH PRACTI)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:N
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MENTAL HEALTH PRACTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 BILTMORE CIRCLE
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11746
Mailing Address - Country:US
Mailing Address - Phone:631-223-3660
Mailing Address - Fax:631-223-3660
Practice Address - Street 1:52 BILTMORE CIRCLE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON STATION
Practice Address - State:NY
Practice Address - Zip Code:11746
Practice Address - Country:US
Practice Address - Phone:631-223-3660
Practice Address - Fax:631-223-3660
Is Sole Proprietor?:No
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003396101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health