Provider Demographics
NPI:1699897884
Name:MAY, LISA (LCSW-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:
Last Name:MAY
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27203 CHIPMANS LN
Mailing Address - Street 2:
Mailing Address - City:FEDERALSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21632-2160
Mailing Address - Country:US
Mailing Address - Phone:410-754-9141
Mailing Address - Fax:
Practice Address - Street 1:27203 CHIPMANS LN
Practice Address - Street 2:
Practice Address - City:FEDERALSBURG
Practice Address - State:MD
Practice Address - Zip Code:21632
Practice Address - Country:US
Practice Address - Phone:410-754-9141
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2018-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEQ100003601041C0700X
MD114511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD435138000Medicaid
DE086513Medicare ID - Type Unspecified