Provider Demographics
NPI:1457179772
Name:MARKS, LISA MICHELE (LMSW)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MICHELE
Last Name:MARKS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6614 CHELWOOD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21209-2608
Mailing Address - Country:US
Mailing Address - Phone:323-533-5727
Mailing Address - Fax:323-533-5727
Practice Address - Street 1:3655 OLD COURT RD
Practice Address - Street 2:
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-3905
Practice Address - Country:US
Practice Address - Phone:410-630-9064
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-26
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD31897104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker