Provider Demographics
NPI:1144307406
Name:TOMES, MARY E (LICSW)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:E
Last Name:TOMES
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4049 GRAND AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1536
Mailing Address - Country:US
Mailing Address - Phone:651-659-2961
Mailing Address - Fax:651-645-7307
Practice Address - Street 1:1821 UNIVERSITY AVE W
Practice Address - Street 2:SUITE N-464
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-2801
Practice Address - Country:US
Practice Address - Phone:651-659-2961
Practice Address - Fax:651-645-7307
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN67051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN6201899OtherUNITED BEHAVIORAL HEALTH
MN37A79MEOtherBLUE CROSS/BLUE SHIELD