Provider Demographics
NPI:1043735251
Name:THOMAS, MAYURI (PHD)
Entity Type:Individual
Prefix:
First Name:MAYURI
Middle Name:
Last Name:THOMAS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6030 MARSHALEE DR STE 563
Mailing Address - Street 2:
Mailing Address - City:ELKRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21075-5987
Mailing Address - Country:US
Mailing Address - Phone:410-929-0460
Mailing Address - Fax:
Practice Address - Street 1:6030 MARSHALEE DR STE 563
Practice Address - Street 2:
Practice Address - City:ELKRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21075-5987
Practice Address - Country:US
Practice Address - Phone:410-929-0460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-08
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLCM621106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist