Healthcare Provider Details

I. General information

NPI: 1710192992
Provider Name (Legal Business Name): LISA HELAINE LEVINE PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 06/03/2026
Certification Date: 06/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16806 EXCALIBER WAY
SANDY SPRING MD
20860-1118
US

IV. Provider business mailing address

16806 EXCALIBER WAY
SANDY SPRING MD
20860-1118
US

V. Phone/Fax

Practice location:
  • Phone: 301-641-3396
  • Fax:
Mailing address:
  • Phone: 301-641-3396
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number04042
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: