Provider Demographics
NPI:1700020443
Name:THOMPSON, PATRICIA ANN (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ANN
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ANN
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:120 STUYVESANT PL
Mailing Address - Street 2:4TH FLOOR SUITE 2
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10301-1989
Mailing Address - Country:US
Mailing Address - Phone:718-447-7422
Mailing Address - Fax:718-447-7421
Practice Address - Street 1:120 STUYVESANT PL
Practice Address - Street 2:4TH FLOOR SUITE 2
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10301-1989
Practice Address - Country:US
Practice Address - Phone:718-447-7422
Practice Address - Fax:718-447-7421
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-24
Last Update Date:2013-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0755891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical