Provider Demographics
NPI:1932314689
Name:PEPPERS, LISA ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LISA
Middle Name:ANN
Last Name:PEPPERS
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12417 OCEAN GTWY STE B-11
Mailing Address - Street 2:PMB 109
Mailing Address - City:OCEAN CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21842-9521
Mailing Address - Country:US
Mailing Address - Phone:443-944-4104
Mailing Address - Fax:
Practice Address - Street 1:12417 OCEAN GTWY STE B-11
Practice Address - Street 2:PMB 109
Practice Address - City:OCEAN CITY
Practice Address - State:MD
Practice Address - Zip Code:21842-9521
Practice Address - Country:US
Practice Address - Phone:443-944-4104
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3511103TC0700X
DEB1-0000677103TC0700X
GA2319103TC0700X
AZ3510103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical