Provider Demographics
NPI:1154955011
Name:E-PSYCHIATRIQ LLC
Entity type:Organization
Organization Name:E-PSYCHIATRIQ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:LANETTE
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP, FNP-NC
Authorized Official - Phone:410-929-6858
Mailing Address - Street 1:5004 HONEYGO CENTER DRIVE
Mailing Address - Street 2:SUITE 102 #197
Mailing Address - City:PERRY HALL
Mailing Address - State:MD
Mailing Address - Zip Code:21128
Mailing Address - Country:US
Mailing Address - Phone:410-929-6858
Mailing Address - Fax:
Practice Address - Street 1:5004 HONEYGO CENTER DR STE 102-197
Practice Address - Street 2:
Practice Address - City:PERRY HALL
Practice Address - State:MD
Practice Address - Zip Code:21128-8963
Practice Address - Country:US
Practice Address - Phone:410-929-6858
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-28
Last Update Date:2025-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119057101Medicaid