Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist |
NPI | 1083879068 |
---|---|
Provider Name | Dr. Douglas Allan Thompson |
First Address | Syracuse, NY 13210-2716 |
Second Address | Syracuse, NY 13210-2716 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2008 |
Last Update Date | 19/07/2008 |