Provider Demographics
NPI:1699885640
Name:WETMORE, THOMAS BANKS (LCSW-C)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BANKS
Last Name:WETMORE
Suffix:
Gender:M
Credentials:LCSW-C
Other - Prefix:MR
Other - First Name:THOMAS
Other - Middle Name:BANKS
Other - Last Name:WETMORE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:390 MAPLE TRL
Mailing Address - Street 2:
Mailing Address - City:CROWNSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21032-1729
Mailing Address - Country:US
Mailing Address - Phone:443-321-2739
Mailing Address - Fax:
Practice Address - Street 1:1831B FOREST DR STE 4
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-4429
Practice Address - Country:US
Practice Address - Phone:410-280-0990
Practice Address - Fax:410-280-0990
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD125701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical