Provider Demographics
NPI:1376014381
Name:KEOUGH, LISA LORRAINE (LCSW-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:LORRAINE
Last Name:KEOUGH
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 CHINQUAPIN ROUND ROAD
Mailing Address - Street 2:SUITE 2-I
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-2811
Mailing Address - Country:US
Mailing Address - Phone:410-204-4436
Mailing Address - Fax:
Practice Address - Street 1:420 CHINQUAPIN ROUND ROAD
Practice Address - Street 2:SUITE 2-I
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:410-204-4436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-17
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD087911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical