Individual
MR. BENLEY STEVENSON THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.
Contact information
Practice address
1960 WASHINGTON ST, ROXBURY, MA 02118-3219
(617) 516-0280
(617) 516-0281
Mailing address
21 JEROME ST, MEDFORD, MA 02155-6711
(857) 251-0013
(781) 483-3740
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
452055800
BHL PROVIDER NUMBER
MA
Enumeration date
09/10/2009
Last updated
09/10/2009
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