Provider Demographics
NPI:1053413377
Name:THOMPSON, BRENDA JOYCE (LCSW-R)
Entity type:Individual
Prefix:MS
First Name:BRENDA
Middle Name:JOYCE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144-46 167 ST.
Mailing Address - Street 2:
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-4826
Mailing Address - Country:US
Mailing Address - Phone:347-262-0512
Mailing Address - Fax:
Practice Address - Street 1:26 COURT ST STE 1210
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11242-1112
Practice Address - Country:US
Practice Address - Phone:347-262-0512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO23662-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYP3591322OtherOXFORD
NY19779POtherHIP
NY02649967Medicaid
NY19779POtherHIP
NYP42021Medicare UPIN
NY07007Medicare ID - Type UnspecifiedMEDICARE