Individual
CRYSTAL DENISE THOMPSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
73 ORIENT AVE, BRENTWOOD, NY 11717-1616
(631) 455-2654
Mailing address
73 ORIENT AVE, BRENTWOOD, NY 11717-1616
(631) 455-2654
Taxonomy
Speciality
Code
Description
License number
State
320700000X
Physical Disabilities Residential Treatment Facility
Primary
717469-1
NY
Other
Enumeration date
12/12/2016
Last updated
12/12/2016
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