Provider Demographics
NPI:1962464412
Name:THOMAS, BONNIE M (LCSW)
Entity Type:Individual
Prefix:
First Name:BONNIE
Middle Name:M
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 371
Mailing Address - Street 2:
Mailing Address - City:WEST KENNEBUNK
Mailing Address - State:ME
Mailing Address - Zip Code:04094-0371
Mailing Address - Country:US
Mailing Address - Phone:207-604-4146
Mailing Address - Fax:
Practice Address - Street 1:116 ALFRED RD UNIT 371
Practice Address - Street 2:
Practice Address - City:WEST KENNEBUNK
Practice Address - State:ME
Practice Address - Zip Code:04094-2015
Practice Address - Country:US
Practice Address - Phone:207-604-4146
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC119071041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431899999Medicaid