1952041535 NPI number — DR. DENISE JOSEPHINE THOMPSON PSY.D.

Table of content: DR. DENISE JOSEPHINE THOMPSON PSY.D. (NPI 1952041535)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952041535 NPI number — DR. DENISE JOSEPHINE THOMPSON PSY.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMPSON
Provider First Name:
DENISE
Provider Middle Name:
JOSEPHINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PSY.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
THOMPSON-SHEARER
Provider Other First Name:
DENISE
Provider Other Middle Name:
JOSEPHINE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
PSY.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952041535
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1970 MICHIGAN AVE BLDG E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
COCOA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32922-5723
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-587-9500
Provider Business Mailing Address Fax Number:
321-735-8007

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1748 GARDEN SAGE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OVIEDO
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32765-4617
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-946-1930
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/31/2022

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: 103TS0200X , with the licence number:  SS1618 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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