Provider Demographics
NPI:1760496236
Name:THOMAS, SANDRA MARIE (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:SANDRA
Middle Name:MARIE
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:SANDRA
Other - Middle Name:
Other - Last Name:FARMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW-C
Mailing Address - Street 1:5900 YORK ROAD
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212
Mailing Address - Country:US
Mailing Address - Phone:410-433-7123
Mailing Address - Fax:410-433-7126
Practice Address - Street 1:5900 YORK ROAD
Practice Address - Street 2:SUITE 106
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212
Practice Address - Country:US
Practice Address - Phone:410-433-7123
Practice Address - Fax:410-433-7126
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2012-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD10403104100000X
DEQ10000748104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD259BOtherBCBS
MDK0360000690OtherBCBS
MDK0360000690OtherBCBS