| Doctor Name: | JEREMY THOMPSON |
| NPI Number: | 1003246307 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | |
| License Number: | 419456309 |
| Business Practice Address: | 54 S 3rd Ave Mount Vernon, NY - 105503303 |
| Business Phone Number: | 9146644042 |
| Business Fax Number: | |
| Mailing Address: | 902 Fairway Grn, MAMARONECK |
| State: | NY |
| Postal Code: | 105434325 |
| Phone Number: | 9145236659 |
| Fax Number: | |
| NPI Enumeration Date: | 11/22/2013 |
| NPI Last Update Date: | 11/22/2013 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YA0400X |
| License Number: | 419456309 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | NY |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Addiction (Substance Use Disorder) |
| Taxonomy Definition: | |