Provider Demographics
NPI:1609544451
Name:THOMAS, GEORGIA NICHOLA (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:GEORGIA
Middle Name:NICHOLA
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 1:6141 BROADWAY APT 3L
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3123
Mailing Address - Country:US
Mailing Address - Phone:646-420-5120
Mailing Address - Fax:
Practice Address - Street 1:6141 BROADWAY APT 3L
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3123
Practice Address - Country:US
Practice Address - Phone:646-420-5120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-04
Last Update Date:2021-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111166104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker