Provider Demographics
NPI:1871937094
Name:THOMPSON CARLOS, JACQUELYN A (CD(DONA))
Entity type:Individual
Prefix:MS
First Name:JACQUELYN
Middle Name:A
Last Name:THOMPSON CARLOS
Suffix:
Gender:F
Credentials:CD(DONA)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 PIERMONT AVE APT 3G
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-4654
Mailing Address - Country:US
Mailing Address - Phone:551-497-3488
Mailing Address - Fax:
Practice Address - Street 1:300 PIERMONT AVE APT 3G
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-4654
Practice Address - Country:US
Practice Address - Phone:551-497-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-18
Last Update Date:2022-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0771643Medicaid