Provider Demographics
NPI:1396040317
Name:LEDERMAN, LISA (LICSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:LEDERMAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:825 BROMLEY ST
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20902-3019
Mailing Address - Country:US
Mailing Address - Phone:202-997-4399
Mailing Address - Fax:301-681-5511
Practice Address - Street 1:5415 CONNECTICUT AVE NW
Practice Address - Street 2:#T43
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2765
Practice Address - Country:US
Practice Address - Phone:202-997-4399
Practice Address - Fax:301-681-5511
Is Sole Proprietor?:No
Enumeration Date:2011-01-22
Last Update Date:2011-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500790221041C0700X
MD133441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical