Provider Demographics
NPI:1396217741
Name:LISA M. OTT, LCSW-C, LLC
Entity Type:Organization
Organization Name:LISA M. OTT, LCSW-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:LISA
Authorized Official - Middle Name:M
Authorized Official - Last Name:OTT
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW-C
Authorized Official - Phone:410-440-5828
Mailing Address - Street 1:9643 GREEN MOON PATH
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-2069
Mailing Address - Country:US
Mailing Address - Phone:410-440-5828
Mailing Address - Fax:
Practice Address - Street 1:8640 GUILFORD RD STE 252
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-2666
Practice Address - Country:US
Practice Address - Phone:410-440-5828
Practice Address - Fax:410-312-7298
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-26
Last Update Date:2018-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health