Provider Demographics
NPI:1811460439
Name:JOY, LISA
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:JOY
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 1:1129 BUSINESS PKWY S STE A
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:MD
Mailing Address - Zip Code:21157-3004
Mailing Address - Country:US
Mailing Address - Phone:667-600-2854
Mailing Address - Fax:667-600-4075
Practice Address - Street 1:1129 BUSINESS PKWY S STE A
Practice Address - Street 2:
Practice Address - City:WESTMINSTER
Practice Address - State:MD
Practice Address - Zip Code:21157-3004
Practice Address - Country:US
Practice Address - Phone:667-600-2854
Practice Address - Fax:667-600-4075
Is Sole Proprietor?:No
Enumeration Date:2019-01-07
Last Update Date:2019-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD103021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD110171418Medicaid