Provider Demographics
NPI:1306981618
Name:GOLDMAN, LISA LIEMAN (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:LIEMAN
Last Name:GOLDMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:LISA
Other - Middle Name:MICHELE
Other - Last Name:LIEMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:6500 EARLY LILY ROW
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-6058
Mailing Address - Country:US
Mailing Address - Phone:410-730-2805
Mailing Address - Fax:410-730-2805
Practice Address - Street 1:10025 GOVERNOR WARFIELD PKWY
Practice Address - Street 2:409
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3340
Practice Address - Country:US
Practice Address - Phone:410-948-0501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2017-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03084103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist