Latisha Dimetria Thompson
Individual provider Active NPI Clinical Social Worker · Philadelphia, PA
NPI 1013770544 · NPPES record last updated Feb 6, 2024
Key facts
- NPI
- 1013770544
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Social Worker 1041C0700X
- License
- SW137326 (PA)
- Practice address
- 3900 Woodland Ave
Philadelphia, PA 19104-4551 - Phone
- (215) 823-5800
- NPI assigned
- Feb 6, 2024
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| SW137326 | PA | MD | Clinical Social Worker |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | SW137326 | PA | Yes |
Addresses
Primary practice location
3900 Woodland Ave
Philadelphia, PA 19104-4551
Mailing address
6025 N Marvine St
Philadelphia, PA 19141-3207
Other providers in Philadelphia, PA
- Jeffrey Campbell Thompson
- Jennifer Thompson
- Kamali Thompson
- Kenneth Thompson
- Kyle Thompson
- Lee Henry Thompson
- Leslie Elizabeth Thompson
- Lynn Thompson
- Marc Thompson
- Maxime Roccario Thompson
All providers in Philadelphia, PA · Clinical Social Worker in Pennsylvania
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Feb 6, 2024. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.