Healthcare Provider Details

I. General information

NPI: 1104917855
Provider Name (Legal Business Name): ELIZABETH BILISKE LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5601 LOCH RAVEN BLVD # 406
BALTIMORE MD
21239-2905
US

IV. Provider business mailing address

2707 CHESWOLDE RD
BALTIMORE MD
21209-3928
US

V. Phone/Fax

Practice location:
  • Phone: 410-532-4540
  • Fax: 410-323-6958
Mailing address:
  • Phone: 410-358-3971
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number07958
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: