Provider Demographics
NPI:1316605736
Name:THOMPSON, SCOTT (MDIV, MS, LMHC)
Entity type:Individual
Prefix:
First Name:SCOTT
Middle Name:
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:MDIV, MS, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:53 JUSTAMERE DR
Mailing Address - Street 2:
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-3901
Mailing Address - Country:US
Mailing Address - Phone:917-279-9960
Mailing Address - Fax:
Practice Address - Street 1:53 JUSTAMERE DR
Practice Address - Street 2:
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-3901
Practice Address - Country:US
Practice Address - Phone:917-279-9960
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002494-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health