Provider Demographics
NPI:1578191680
Name:WAINWRIGHT, LISA MARIE (LMSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:WAINWRIGHT
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:82 LIBERTY ST
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3821
Mailing Address - Country:US
Mailing Address - Phone:443-739-0627
Mailing Address - Fax:
Practice Address - Street 1:82 LIBERTY ST
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-3821
Practice Address - Country:US
Practice Address - Phone:443-739-0627
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD258271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical