| Doctor Name: | MR. BENLEY STEVENSON THOMPSON |
| NPI Number: | 1033442843 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | M.A. |
| License Number: | |
| Business Practice Address: | 1960 Washington St Roxbury, MA - 021183219 |
| Business Phone Number: | 6175160280 |
| Business Fax Number: | 6175160281 |
| Mailing Address: | 21 Jerome St, MEDFORD |
| State: | MA |
| Postal Code: | 021556711 |
| Phone Number: | 8572510013 |
| Fax Number: | 7814833740 |
| NPI Enumeration Date: | 09/10/2009 |
| NPI Last Update Date: | 09/10/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |