Provider Demographics
NPI:1477580728
Name:CHILDS, LISA SALLADIN (MSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:SALLADIN
Last Name:CHILDS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16260 FALLS RD
Mailing Address - Street 2:
Mailing Address - City:MONKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21111-1621
Mailing Address - Country:US
Mailing Address - Phone:410-409-8731
Mailing Address - Fax:443-238-0201
Practice Address - Street 1:16260 FALLS RD
Practice Address - Street 2:
Practice Address - City:MONKTON
Practice Address - State:MD
Practice Address - Zip Code:21111-1621
Practice Address - Country:US
Practice Address - Phone:410-409-8731
Practice Address - Fax:443-238-0201
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD086661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD402510501Medicaid