Healthcare Provider Details

I. General information

NPI: 1003465568
Provider Name (Legal Business Name): SHANNON D THOMAS LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2019
Last Update Date: 09/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

514 POPLAR ST
CAMBRIDGE MD
21613-1834
US

IV. Provider business mailing address

402 WOODVIEW SQ APT H
SALISBURY MD
21804-2904
US

V. Phone/Fax

Practice location:
  • Phone: 800-867-2395
  • Fax:
Mailing address:
  • Phone: 410-422-5633
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number24314
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: