Provider Demographics
NPI:1063550937
Name:THOMPSON, ELIZABETH L (LCSWR)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:L
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:WOODSIDE ELEMENTARY SCHOOL
Mailing Address - Street 2:DEPEW STREET
Mailing Address - City:PEEKSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:10566
Mailing Address - Country:US
Mailing Address - Phone:914-734-1359
Mailing Address - Fax:914-734-1638
Practice Address - Street 1:WOODSIDE ELEMENTARY SCHOOL
Practice Address - Street 2:DEPEW STREET
Practice Address - City:PEEKSKILL
Practice Address - State:NY
Practice Address - Zip Code:10566
Practice Address - Country:US
Practice Address - Phone:914-734-1359
Practice Address - Fax:914-734-1638
Is Sole Proprietor?:No
Enumeration Date:2007-02-02
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052803-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY200808OtherHEALTHNET
NYN3P631Medicare PIN