Provider Demographics
NPI:1306878376
Name:PATOTA, THOMAS JOSEPH (LICSW)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:JOSEPH
Last Name:PATOTA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1413 ANNAPOLIS ROAD
Mailing Address - Street 2:SUITE #207
Mailing Address - City:ODENTON
Mailing Address - State:MD
Mailing Address - Zip Code:21113
Mailing Address - Country:US
Mailing Address - Phone:301-593-8111
Mailing Address - Fax:301-593-6648
Practice Address - Street 1:1413 ANNAPOLIS ROAD
Practice Address - Street 2:SUITE #207
Practice Address - City:ODENTON
Practice Address - State:MD
Practice Address - Zip Code:21113
Practice Address - Country:US
Practice Address - Phone:774-202-5121
Practice Address - Fax:301-593-6648
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-07
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10170341041C0700X
MD167331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1892215Medicaid
MA1892215Medicaid