Provider Demographics
NPI:1558531137
Name:FERENTZ, LISA ROSLYN (MSW LCSW-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:ROSLYN
Last Name:FERENTZ
Suffix:
Gender:F
Credentials:MSW LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3701 OLD COURT RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-3909
Mailing Address - Country:US
Mailing Address - Phone:410-486-0351
Mailing Address - Fax:
Practice Address - Street 1:3701 OLD COURT RD
Practice Address - Street 2:SUITE 5
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3909
Practice Address - Country:US
Practice Address - Phone:410-486-0351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-10
Last Update Date:2008-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD055711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical