Healthcare Provider Details

I. General information

NPI: 1114123155
Provider Name (Legal Business Name): THOMAS LAWRENCE FLOYD ACSW, LCSW-C, LICSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: THOMAS L. FLOYD ACSW, LCSW-C, LICSW

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 12/29/2020
Certification Date: 12/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1845 FOGGY BOTTOM COURT
SUNDERLAND MD
20689-3008
US

IV. Provider business mailing address

1845 FOGGY BOTTOM COURT
SUNDERLAND MD
20689-3008
US

V. Phone/Fax

Practice location:
  • Phone: 301-655-0842
  • Fax:
Mailing address:
  • Phone: 301-655-0842
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14617
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC301300
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: