Provider Demographics
NPI:1437390267
Name:LISA JOAN REARDON LICSW
Entity Type:Organization
Organization Name:LISA JOAN REARDON LICSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:JOAN
Authorized Official - Last Name:REARDON
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:202-526-4445
Mailing Address - Street 1:1325 QUINCY ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2615
Mailing Address - Country:US
Mailing Address - Phone:202-526-4445
Mailing Address - Fax:202-526-7401
Practice Address - Street 1:1325 QUINCY ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2615
Practice Address - Country:US
Practice Address - Phone:202-526-4445
Practice Address - Fax:202-526-7401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-06
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC301995261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC6510-0001OtherBLUECROSS BLUESHIELD
DC116815OtherKAISER PERMANENTE
DC648724Medicare PIN