Healthcare Provider Details

I. General information

NPI: 1578191680
Provider Name (Legal Business Name): LISA MARIE WAINWRIGHT LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2020
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 REVOLUTION ST
HAVRE DE GRACE MD
21078-3718
US

IV. Provider business mailing address

82 LIBERTY ST
ABERDEEN MD
21001-3821
US

V. Phone/Fax

Practice location:
  • Phone: 410-919-9665
  • Fax: 844-444-1143
Mailing address:
  • Phone: 443-739-0627
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number25827
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: