Provider Demographics
NPI:1144747445
Name:THOMAS, KEDAR GRACE (LICSW)
Entity Type:Individual
Prefix:MS
First Name:KEDAR
Middle Name:GRACE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 FORT HILL AVE APT 1
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:MA
Mailing Address - Zip Code:01852-2766
Mailing Address - Country:US
Mailing Address - Phone:978-995-4671
Mailing Address - Fax:
Practice Address - Street 1:7 SUMMER ST
Practice Address - Street 2:
Practice Address - City:CHELMSFORD
Practice Address - State:MA
Practice Address - Zip Code:01824-3076
Practice Address - Country:US
Practice Address - Phone:978-256-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-28
Last Update Date:2017-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1199221041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical