1285715946 NPI number — MS. MARY JANE THOMAS LCSW-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285715946 NPI number — MS. MARY JANE THOMAS LCSW-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
THOMAS
Provider First Name:
MARY JANE
Provider Middle Name:
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1285715946
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
823 KINGSTON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21212-1909
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-377-4767
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7801 YORK RD
Provider Second Line Business Practice Location Address:
SUITE 215
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-7446
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-337-7772
Provider Business Practice Location Address Fax Number:
410-337-8729
Provider Enumeration Date:
10/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  07909 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: QE24MJ . This is a "BCBS ID #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: R9340001 . This is a "BLUE CHOICE ID #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 222022 . This is a "COMPSYCH ID #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 529553 06 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 41734 . This is a "AMERICAN PSYCH SYSTEMS ID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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