Provider Demographics
NPI:1700970787
Name:THOMAS, KEELEY MCCORMACK (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:KEELEY
Middle Name:MCCORMACK
Last Name:THOMAS
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7702 DUNMANWAY
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21222-5436
Mailing Address - Country:US
Mailing Address - Phone:410-282-1792
Mailing Address - Fax:
Practice Address - Street 1:5720 EXECUTIVE DR STE 102
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-1757
Practice Address - Country:US
Practice Address - Phone:104-780-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2019-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD155361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical