Provider Demographics
NPI:1710270277
Name:HOWARD, LISA MARIE (LICSW, MAC)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:HOWARD
Suffix:
Gender:F
Credentials:LICSW, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 GIBBS STREET
Mailing Address - Street 2:473
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850
Mailing Address - Country:US
Mailing Address - Phone:602-460-2260
Mailing Address - Fax:
Practice Address - Street 1:120 GIBBS ST
Practice Address - Street 2:473
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-0361
Practice Address - Country:US
Practice Address - Phone:602-460-2260
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-17
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500793421041C0700X
AZLASAC-13195101YA0400X
507588101YA0400X
AZLMSW-12876104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)