Provider Demographics
NPI:1154617587
Name:MANTELL, LISSA (LICSW, LCSW-C)
Entity type:Individual
Prefix:
First Name:LISSA
Middle Name:
Last Name:MANTELL
Suffix:
Gender:F
Credentials:LICSW, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8609 2ND AVE STE 307B
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-3361
Mailing Address - Country:US
Mailing Address - Phone:301-960-8546
Mailing Address - Fax:
Practice Address - Street 1:8609 2ND AVE STE 307B
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-3361
Practice Address - Country:US
Practice Address - Phone:301-960-8546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD178981041C0700X
DCLC500789201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical