Provider Demographics
NPI:1568516888
Name:KEHLE, LISA MARIA (MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIA
Last Name:KEHLE
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 1:9623 ROCKSPARKLE ROW
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-4337
Mailing Address - Country:US
Mailing Address - Phone:410-740-9285
Mailing Address - Fax:
Practice Address - Street 1:1406B CRAIN HWY S
Practice Address - Street 2:SUITE 301
Practice Address - City:GLEN BURNIE
Practice Address - State:MD
Practice Address - Zip Code:21061-4099
Practice Address - Country:US
Practice Address - Phone:410-760-5588
Practice Address - Fax:410-760-9727
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD115051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical