Provider Demographics
NPI:1255924114
Name:STANFORD, LISA A (LCSW-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:A
Last Name:STANFORD
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6912 MAYFAIR TER
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-5211
Mailing Address - Country:US
Mailing Address - Phone:240-272-1743
Mailing Address - Fax:
Practice Address - Street 1:4401 SILVERBROOK LN APT B304
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-6887
Practice Address - Country:US
Practice Address - Phone:240-272-1743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-11
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC2000024301041C0700X
MD221781041C0700X
VA09040161711041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical