Provider Demographics
NPI:1578606281
Name:LIST, LYNNE (LCSW - C)
Entity Type:Individual
Prefix:MS
First Name:LYNNE
Middle Name:
Last Name:LIST
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 1:3919 ASPEN ST
Mailing Address - Street 2:
Mailing Address - City:CHEVY CHASE
Mailing Address - State:MD
Mailing Address - Zip Code:20815-5060
Mailing Address - Country:US
Mailing Address - Phone:301-656-7633
Mailing Address - Fax:301-915-0079
Practice Address - Street 1:3919 ASPEN ST
Practice Address - Street 2:
Practice Address - City:CHEVY CHASE
Practice Address - State:MD
Practice Address - Zip Code:20815-5060
Practice Address - Country:US
Practice Address - Phone:301-775-4523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-14
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC300351041C0700X
MD030671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD118031200Medicaid
MD118031200Medicaid