Provider Demographics
NPI:1811577463
Name:THOMAS, TAVON LAMONTE (LMSW)
Entity Type:Individual
Prefix:
First Name:TAVON
Middle Name:LAMONTE
Last Name:THOMAS
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E REDWOOD ST APT 1828
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21202-1354
Mailing Address - Country:US
Mailing Address - Phone:410-292-1732
Mailing Address - Fax:
Practice Address - Street 1:7500 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21234-6900
Practice Address - Country:US
Practice Address - Phone:443-708-8139
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-08
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD270071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical