Provider Demographics
NPI:1770699274
Name:THOMPSON, CAROL L
Entity type:Individual
Prefix:
First Name:CAROL
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 DANIS AVENUE
Mailing Address - Street 2:
Mailing Address - City:POUGHKEEPSIE
Mailing Address - State:NY
Mailing Address - Zip Code:12603-2408
Mailing Address - Country:US
Mailing Address - Phone:845-485-3500
Mailing Address - Fax:845-485-8780
Practice Address - Street 1:510 HAIGHT AVENUE
Practice Address - Street 2:SUITE 203 SPECTRUM BEHAVIORAL MANAGEMENT SERV INC
Practice Address - City:POUGHKEEPSIE
Practice Address - State:NY
Practice Address - Zip Code:12603-2408
Practice Address - Country:US
Practice Address - Phone:845-485-3500
Practice Address - Fax:845-485-8780
Is Sole Proprietor?:No
Enumeration Date:2006-08-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0623511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
1033150OtherBEACON HEALTH STRAT
499716OtherVALUE OPTIONS
2182701OtherCIGNA BEH HEALTH
699170OtherMVP HEALTH CARE
499716OtherVALUE OPTIONS
NYN1P301Medicare ID - Type Unspecified