Provider Demographics
NPI:1295933489
Name:THOMPSON, NOLAN M (LCSW)
Entity type:Individual
Prefix:
First Name:NOLAN
Middle Name:M
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 1:2 VILLA RD
Mailing Address - Street 2:
Mailing Address - City:WESTBROOK
Mailing Address - State:ME
Mailing Address - Zip Code:04092-3628
Mailing Address - Country:US
Mailing Address - Phone:207-415-9326
Mailing Address - Fax:207-899-4951
Practice Address - Street 1:755 ROOSEVELT TRL # 3B
Practice Address - Street 2:
Practice Address - City:WINDHAM
Practice Address - State:ME
Practice Address - Zip Code:04062-5341
Practice Address - Country:US
Practice Address - Phone:207-415-9326
Practice Address - Fax:207-899-4951
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2010-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC36251041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME219870000Medicaid