Provider Demographics
NPI:1710406004
Name:INTHISANE, ELISSA LOPEZ (MSW, LCSW-C)
Entity Type:Individual
Prefix:
First Name:ELISSA
Middle Name:LOPEZ
Last Name:INTHISANE
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 1:8120 WOODMONT AVE STE 840
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-2789
Mailing Address - Country:US
Mailing Address - Phone:240-618-2889
Mailing Address - Fax:240-623-9858
Practice Address - Street 1:8120 WOODMONT AVE STE 840
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-2789
Practice Address - Country:US
Practice Address - Phone:240-618-2889
Practice Address - Fax:240-623-9858
Is Sole Proprietor?:No
Enumeration Date:2017-09-18
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD223711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical