Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | ||
Y | 1041C0700X | Clinical Social Worker | 114632 | MA |
N | 1041S0200X | School Social Worker |
NPI | 1073768859 |
---|---|
Provider Name | Rebecca Colacchio Thompson |
First Address | Waltham, MA 02453-6577 |
Second Address | Newton Centre, MA 02459-2454 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2008 |
Last Update Date | 20/11/2008 |