Provider Demographics
NPI:1912368648
Name:EMERY, LISA R
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:R
Last Name:EMERY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8720 GEORGIA AVE STE 302
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3658
Mailing Address - Country:US
Mailing Address - Phone:301-589-0866
Mailing Address - Fax:
Practice Address - Street 1:8720 GEORGIA AVE STE 302
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3658
Practice Address - Country:US
Practice Address - Phone:301-589-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-03-08
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC302376101YM0800X, 1041C0700X
MD217071041C0700X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health