1861506966 NPI number — MR. BENJAMIN F THOMPSON MSW LICSW BCD

Table of content: MR. BENJAMIN F THOMPSON MSW LICSW BCD (NPI 1861506966)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861506966 NPI number — MR. BENJAMIN F THOMPSON MSW LICSW BCD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
BENJAMIN
Provider Middle Name:
F
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MSW LICSW BCD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861506966
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
38 MULBERRY STREET
Provider Second Line Business Mailing Address:
P.O. BOX 479
Provider Business Mailing Address City Name:
LEEDS
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01053
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
413-585-9452
Provider Business Mailing Address Fax Number:
413-585-9452

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
38 MULBERRY STREET
Provider Second Line Business Practice Location Address:
P.O. BOX 479
Provider Business Practice Location Address City Name:
LEEDS
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01053
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
413-585-9452
Provider Business Practice Location Address Fax Number:
413-585-9452
Provider Enumeration Date:
08/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 104100000X , with the licence number:  105276 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: P03324 . This is a "BC/BS P03324" identifier . This identifiers is of the category "OTHER".




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