Provider Demographics
NPI:1417416165
Name:LYSS, YISROEL MORDECHAI (LMFT, LCMFT)
Entity type:Individual
Prefix:
First Name:YISROEL
Middle Name:MORDECHAI
Last Name:LYSS
Suffix:
Gender:M
Credentials:LMFT, LCMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3607 BANCROFT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-3229
Mailing Address - Country:US
Mailing Address - Phone:443-386-3636
Mailing Address - Fax:
Practice Address - Street 1:1314 BEDFORD AVE STE 113
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-3737
Practice Address - Country:US
Practice Address - Phone:203-706-8747
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-12
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YA0400X, 101YP2500X
MDLCM987106H00000X
CT002588106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional