Provider Demographics
NPI:1285715946
Name:THOMAS, MARY JANE (LCSW-C)
Entity type:Individual
Prefix:MS
First Name:MARY JANE
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 KINGSTON RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-1909
Mailing Address - Country:US
Mailing Address - Phone:410-377-4767
Mailing Address - Fax:
Practice Address - Street 1:7801 YORK RD
Practice Address - Street 2:SUITE 215
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-7446
Practice Address - Country:US
Practice Address - Phone:410-337-7772
Practice Address - Fax:410-337-8729
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD079091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQE24MJOtherBCBS ID #
MDR9340001OtherBLUE CHOICE ID #
MD222022OtherCOMPSYCH ID #
MD529553 06OtherBLUE CROSS BLUE SHIELD
MD41734OtherAMERICAN PSYCH SYSTEMS ID
MD529553 06OtherBLUE CROSS BLUE SHIELD