Provider Demographics
NPI:1265697676
Name:PETERSON, LISA ANN (LCSW-C)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:ANN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:ANN PETERSON
Other - Last Name:EASTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW & LSWA
Mailing Address - Street 1:8366 MARY LEE LN
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20723-1192
Mailing Address - Country:US
Mailing Address - Phone:301-497-4425
Mailing Address - Fax:
Practice Address - Street 1:8366 MARY LEE LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20723-1192
Practice Address - Country:US
Practice Address - Phone:301-497-4425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD094141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical