=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104917855
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ELIZABETH BILISKE LCSW-C
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/27/2006
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5601 LOCH RAVEN BLVD # 406
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21239-2905
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-532-4540
-----------------------------------------------------
Fax | 410-323-6958
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2707 CHESWOLDE RD
-----------------------------------------------------
City | BALTIMORE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21209-3928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-358-3971
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 07958
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------