Healthcare Provider Details

I. General information

NPI: 1548512437
Provider Name (Legal Business Name): LISA LUSE LICSW, LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2012
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6430 ROCKLEDGE DR
BETHESDA MD
20817-1805
US

IV. Provider business mailing address

2912 RITTENHOUSE ST NW
WASHINGTON DC
20015-1524
US

V. Phone/Fax

Practice location:
  • Phone: 202-607-2497
  • Fax:
Mailing address:
  • Phone: 202-365-0178
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number17772
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLC50079498
License Number StateDC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: