Provider Demographics
NPI:1568683001
Name:LUSTIG, PATTI LEHMAN (LCSW-C)
Entity Type:Individual
Prefix:
First Name:PATTI
Middle Name:LEHMAN
Last Name:LUSTIG
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29622 POLKS ROAD
Mailing Address - Street 2:
Mailing Address - City:PRINCESS ANNE
Mailing Address - State:MD
Mailing Address - Zip Code:21853
Mailing Address - Country:US
Mailing Address - Phone:410-654-1917
Mailing Address - Fax:410-548-9056
Practice Address - Street 1:109 HIGH STREET
Practice Address - Street 2:
Practice Address - City:SALISBURY
Practice Address - State:DE
Practice Address - Zip Code:21801
Practice Address - Country:US
Practice Address - Phone:410-546-1692
Practice Address - Fax:410-548-9056
Is Sole Proprietor?:No
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD030691041C0700X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD349SMedicare UPIN
MD241LMedicare ID - Type Unspecified