Provider Demographics
NPI:1194986851
Name:THOMPSON, ANDREW J (MSW, LICSW)
Entity type:Individual
Prefix:MR
First Name:ANDREW
Middle Name:J
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4408 69TH AVE N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-1739
Mailing Address - Country:US
Mailing Address - Phone:763-566-3650
Mailing Address - Fax:763-566-4217
Practice Address - Street 1:4408 69TH AVE N
Practice Address - Street 2:
Practice Address - City:BROOKLYN CENTER
Practice Address - State:MN
Practice Address - Zip Code:55429-1739
Practice Address - Country:US
Practice Address - Phone:763-566-3650
Practice Address - Fax:763-566-4217
Is Sole Proprietor?:No
Enumeration Date:2008-06-24
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN190011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical