Healthcare Provider Details

I. General information

NPI: 1699897884
Provider Name (Legal Business Name): LISA MAY LCSW-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2007
Last Update Date: 07/21/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27203 CHIPMANS LN
FEDERALSBURG MD
21632
US

IV. Provider business mailing address

27203 CHIPMANS LN
FEDERALSBURG MD
21632-2160
US

V. Phone/Fax

Practice location:
  • Phone: 410-754-9141
  • Fax:
Mailing address:
  • Phone: 410-754-9141
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ10000360
License Number StateDE
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11451
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: