Basic Information
| Provider Information | |||||||||
| NPI: | 1548439490 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | THOMPSON-PARADY | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | EVE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 43 HATCH DR STE 210 | ||||||||
| Address2: | |||||||||
| City: | CARIBOU | ||||||||
| State: | ME | ||||||||
| PostalCode: | 047362039 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2074933361 | ||||||||
| FaxNumber: | 2074924889 | ||||||||
| Practice Location | |||||||||
| Address1: | 1 EDGEMONT DR | ||||||||
| Address2: | |||||||||
| City: | PRESQUE ISLE | ||||||||
| State: | ME | ||||||||
| PostalCode: | 04769 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2077643319 | ||||||||
| FaxNumber: | 2077685377 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2008 | ||||||||
| LastUpdateDate: | 06/07/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | LC12607 | ME | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
ID Information
| ID | Type | State | Issuer | Description | 432864299 | 05 | ME | MEDICAID |