Provider Demographics
NPI:1104976075
Name:THOMPSON, DENNIS MERLE (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:MERLE
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36977 PARK AVE
Mailing Address - Street 2:
Mailing Address - City:BURNEY
Mailing Address - State:CA
Mailing Address - Zip Code:96013-4067
Mailing Address - Country:US
Mailing Address - Phone:530-335-4004
Mailing Address - Fax:530-335-4023
Practice Address - Street 1:36977 PARK AVE
Practice Address - Street 2:
Practice Address - City:BURNEY
Practice Address - State:CA
Practice Address - Zip Code:96013-4067
Practice Address - Country:US
Practice Address - Phone:530-335-4004
Practice Address - Fax:530-335-4023
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2011-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 270901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1104976075Medicare UPIN