Provider Demographics
NPI:1194164582
Name:KAYS, LISA KATHLEEN (LICSW, LGSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KATHLEEN
Last Name:KAYS
Suffix:
Gender:F
Credentials:LICSW, LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1660 LANIER PL NW APT 305
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2946
Mailing Address - Country:US
Mailing Address - Phone:202-350-1640
Mailing Address - Fax:
Practice Address - Street 1:1660 LANIER PL NW APT 305
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2946
Practice Address - Country:US
Practice Address - Phone:202-350-1640
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-18
Last Update Date:2013-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLGSW 16958104100000X
DCLC500797861041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker