MEDICARE: MRS. LISA EMRALINO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor	101Y00000X	DC

General Provider Information

NPI Number	:	1619540549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA EMRALINO

Provider Business Mailing Address
First Line	:	2647 SHADYSIDE AVE APT T2
Second Line	:
City	:	SUITLAND
State	:	MD
Zip	:	20746-5014
Country	:	US
Telephone Number	:	240-755-9329
Fax Number	:

Provider Business Practice Location Address
First Line	:	1430 CEDAR ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-5012
Country	:	US
Telephone Number	:	202-497-8771
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/19/2021
Last Update Date	:	07/19/2021

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