Provider Demographics
NPI:1407372022
Name:MARTIN DEL CAMPO LUSTIG, LILIANA
Entity Type:Individual
Prefix:
First Name:LILIANA
Middle Name:
Last Name:MARTIN DEL CAMPO LUSTIG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:LILIANA
Other - Middle Name:
Other - Last Name:MARTIN DEL CAMPO LUSTIG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1325 18TH STREET NW #707
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-7590
Mailing Address - Country:US
Mailing Address - Phone:202-390-4505
Mailing Address - Fax:
Practice Address - Street 1:1317 RHODE ISLAND SUITE 206 NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005
Practice Address - Country:US
Practice Address - Phone:202-390-4505
Practice Address - Fax:202-390-4505
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2017-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500812111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical