Provider Demographics
NPI:1821102690
Name:PIECHOWSKI, LISA D (PHD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:D
Last Name:PIECHOWSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1997 ANNAPOLIS EXCHANGE PKWY STE 300
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-3273
Mailing Address - Country:US
Mailing Address - Phone:240-863-2310
Mailing Address - Fax:240-233-2039
Practice Address - Street 1:1997 ANNAPOLIS EXCHANGE PKWY STE 300
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401
Practice Address - Country:US
Practice Address - Phone:240-863-2310
Practice Address - Fax:240-233-2039
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2018-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001993103TC0700X, 103TF0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT080383OtherVALUE OPTIONS
CT060001993CT01OtherBLUE CROSS BLUE SHIELD
CT189325OtherMHS
CTHAS682OtherOXFORD