Provider Demographics
NPI:1780996116
Name:THOMPSON, BEVERLY G (MA)
Entity type:Individual
Prefix:
First Name:BEVERLY
Middle Name:G
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2350 BROADWAY STE 811
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10024-3214
Mailing Address - Country:US
Mailing Address - Phone:212-362-5081
Mailing Address - Fax:
Practice Address - Street 1:2350 BROADWAY STE 811
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-3214
Practice Address - Country:US
Practice Address - Phone:212-362-5081
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-14
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJNJDE 1005-10 12/822355S0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2355S0801XSpeech, Language and Hearing Service ProvidersSpecialist/TechnologistSpeech-Language Assistant