Provider Demographics
NPI:1417784836
Name:THOMPSON, STEPHEN HARVARD (LCSW)
Entity type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:HARVARD
Last Name:THOMPSON
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:167 COLERIDGE ST
Mailing Address - Street 2:
Mailing Address - City:EAST BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-1575
Mailing Address - Country:US
Mailing Address - Phone:617-413-0761
Mailing Address - Fax:
Practice Address - Street 1:199 ROSEWOOD DR
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1398
Practice Address - Country:US
Practice Address - Phone:978-291-7065
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-18
Last Update Date:2024-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2307521041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical