Individual provider Active NPI

Laurance Thompson, M.S.

  • Clinical Psychologist
  • Berlin, VT
National Provider Identifier
1336259365
Registry record updated Jul 8, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
047-00062 Issued in VT
Practice address
130 Fisher Rd Ste 1-6
Berlin, VT 05602-9000
Phone
(802) 272-5919
Fax
(802) 223-7444
NPI assigned
Aug 31, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jul 8, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 047-00062 VT Primary

Addresses

Primary practice location

130 Fisher Rd Ste 1-6
Berlin, VT 05602-9000

Mailing address

2559 Eagle Peak Rd
West Brookfield, VT 05060-9794
Phone (802) 272-5919

Other identifiers 1

IdentifierTypeStateIssuer
1010122MedicaidVT

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Master of Science

State licenses

LicenseStateTypeSpecialty
047-00062VTMDClinical Psychologist

Interoperability endpoints

  • Direct secure messaging: lthompson235870@direct.uvmhealth.org

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1156982400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1336259365",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2559 EAGLE PEAK RD",
            "city": "WEST BROOKFIELD",
            "state": "VT",
            "postal_code": "050609794",
            "telephone_number": "802-272-5919"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 FISHER RD STE 1-6",
            "city": "BERLIN",
            "state": "VT",
            "postal_code": "056029000",
            "telephone_number": "802-272-5919",
            "fax_number": "802-223-7444"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "THOMPSON",
        "first_name": "LAURANCE",
        "name_prefix": "Mr.",
        "credential": "M.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-08-31",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VT",
            "license": "047-00062",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1010122",
            "state": "VT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Berlin, VT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.