Provider Demographics
NPI:1174706295
Name:PEASE, LISA ELIZABETH (LCSW-C)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:ELIZABETH
Last Name:PEASE
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 1:106 MILFORD ST
Mailing Address - Street 2:SUITE 501-B
Mailing Address - City:SALISBURY
Mailing Address - State:MD
Mailing Address - Zip Code:21804-6953
Mailing Address - Country:US
Mailing Address - Phone:410-546-1692
Mailing Address - Fax:410-548-9056
Practice Address - Street 1:106 MILFORD ST
Practice Address - Street 2:SUITE 501-B
Practice Address - City:SALISBURY
Practice Address - State:MD
Practice Address - Zip Code:21804-6953
Practice Address - Country:US
Practice Address - Phone:410-546-1692
Practice Address - Fax:410-548-9056
Is Sole Proprietor?:No
Enumeration Date:2007-12-12
Last Update Date:2014-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD102081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD119591300Medicaid
MDS118Medicare PIN