Provider Demographics
NPI:1003465568
Name:THOMAS, SHANNON D (LMSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:D
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:402 WOODVIEW SQ APT H
Mailing Address - Street 2:
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-2904
Mailing Address - Country:US
Mailing Address - Phone:410-422-5633
Mailing Address - Fax:
Practice Address - Street 1:514 POPLAR ST
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-1834
Practice Address - Country:US
Practice Address - Phone:800-867-2395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-08
Last Update Date:2019-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD24314104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker