Provider Demographics
NPI:1124550728
Name:THOMAS, BENOY (MSW, LCSW-C, LICSW)
Entity type:Individual
Prefix:
First Name:BENOY
Middle Name:
Last Name:THOMAS
Suffix:
Gender:M
Credentials:MSW, LCSW-C, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15112 PEACHSTONE DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20905-4317
Mailing Address - Country:US
Mailing Address - Phone:240-593-6810
Mailing Address - Fax:
Practice Address - Street 1:19709 EXECUTIVE PARK CIR
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-2639
Practice Address - Country:US
Practice Address - Phone:240-593-6810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-01
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD092431041C0700X
DCLC3027191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical