MEDICARE: LISAMARIE EUSTICE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	13843	MD

General Provider Information

NPI Number	:	1558695338
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LISAMARIE EUSTICE, LLC

Provider Business Mailing Address
First Line	:	4829 WEST LN
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-5317
Country	:	US
Telephone Number	:	301-802-5697
Fax Number	:

Provider Business Practice Location Address
First Line	:	4829 WEST LN
Second Line	:
City	:	BETHESDA
State	:	MD
Zip	:	20814-5317
Country	:	US
Telephone Number	:	301-802-5697
Fax Number	:

Authorized Official
Title or Position	:	CLINICIAN/BUSINESS CO-OWNER
Name	:	MS. LISAMARIE EUSTICE
Credential	:	LCSW-C
Telephone Number	:	301-802-5697

Provider Enumeration Date	:	09/25/2009
Last Update Date	:	10/18/2012

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