Provider Demographics
NPI:1740334960
Name:WODISKA, LORRAINE B (PHD)
Entity type:Individual
Prefix:DR
First Name:LORRAINE
Middle Name:B
Last Name:WODISKA
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 1:7910 WOODMONT AVE
Mailing Address - Street 2:SUITE 1101
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20814-3002
Mailing Address - Country:US
Mailing Address - Phone:301-907-9070
Mailing Address - Fax:301-907-6667
Practice Address - Street 1:7910 WOODMONT AVE
Practice Address - Street 2:SUITE 1101
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20814-3002
Practice Address - Country:US
Practice Address - Phone:301-907-9070
Practice Address - Fax:301-907-6667
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD2375103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist