Provider Demographics
NPI:1285812826
Name:THOMPSON, VERONIQUE LEE (PHD)
Entity type:Individual
Prefix:
First Name:VERONIQUE
Middle Name:LEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2728 DURANT AVE
Mailing Address - Street 2:C/O WRIGHT INSTITUTE
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1725
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2728 DURANT AVE
Practice Address - Street 2:C/O WRIGHT INSTITUTE
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1725
Practice Address - Country:US
Practice Address - Phone:510-841-9230
Practice Address - Fax:510-841-0167
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-06
Last Update Date:2008-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13620103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical