Provider Demographics
NPI:1710595517
Name:FARINELLI, LISA (RN, MBA)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:FARINELLI
Suffix:
Gender:F
Credentials:RN, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 BAYVIEW BLVD RM 1A840
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21224-2816
Mailing Address - Country:US
Mailing Address - Phone:301-640-1924
Mailing Address - Fax:
Practice Address - Street 1:251 BAYVIEW BLDV
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21224
Practice Address - Country:US
Practice Address - Phone:301-640-1924
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-17
Last Update Date:2020-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR149835163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)