Provider Demographics
NPI:1023382421
Name:LISS, JUDITH WENDKOS (MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:JUDITH
Middle Name:WENDKOS
Last Name:LISS
Suffix:
Gender:F
Credentials:MSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4405 E WEST HWY
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-4522
Mailing Address - Country:US
Mailing Address - Phone:301-652-1582
Mailing Address - Fax:
Practice Address - Street 1:4405 EAST WEST HWY
Practice Address - Street 2:SUITE 301
Practice Address - City:BETEHSDA
Practice Address - State:MD
Practice Address - Zip Code:20814-4522
Practice Address - Country:US
Practice Address - Phone:301-652-1582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD134341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical