Provider Demographics
NPI:1700988938
Name:THOMPSON, LISA D (MSW LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MSW LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3444
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01004-3444
Mailing Address - Country:US
Mailing Address - Phone:413-586-5800
Mailing Address - Fax:413-586-5800
Practice Address - Street 1:217 RUSSELL ST
Practice Address - Street 2:
Practice Address - City:HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01035-9521
Practice Address - Country:US
Practice Address - Phone:413-586-5800
Practice Address - Fax:413-586-5800
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-01
Last Update Date:2010-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10207131041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical