Provider Demographics
NPI:1831372580
Name:THOMPSON, DANIEL L (LICSW)
Entity type:Individual
Prefix:
First Name:DANIEL
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2448
Mailing Address - Country:US
Mailing Address - Phone:401-584-9596
Mailing Address - Fax:401-315-5569
Practice Address - Street 1:97 CROSS ST
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2448
Practice Address - Country:US
Practice Address - Phone:401-584-9596
Practice Address - Fax:401-315-5569
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2016-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW003831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI7002713Medicaid
RI37350OtherBLUE CROSS OF RI
RI414294OtherBLUE CHIP
RI809005948OtherMEDICARE