Provider Demographics
NPI:1386781938
Name:FREEMAN, LISA (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10715 CHARTER DR
Mailing Address - Street 2:SUITE 270
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-2882
Mailing Address - Country:US
Mailing Address - Phone:410-992-5078
Mailing Address - Fax:410-992-9669
Practice Address - Street 1:10715 CHARTER DR
Practice Address - Street 2:SUITE 270
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-2882
Practice Address - Country:US
Practice Address - Phone:410-992-5078
Practice Address - Fax:410-992-9669
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03904103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDGQ75LM 61937403OtherBCBS CAREFIRST MD
DC88460001OtherCAREFIRST BCBS D.C.
MDGQ75LM 61937403OtherBCBS CAREFIRST MD