Provider Demographics
NPI:1366779027
Name:HILL, LISA W (PSYD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:W
Last Name:HILL
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LISA
Other - Middle Name:C
Other - Last Name:WAGNER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:3 WASHINGTON CIR NW
Mailing Address - Street 2:SUITE 403
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2356
Mailing Address - Country:US
Mailing Address - Phone:202-550-2762
Mailing Address - Fax:
Practice Address - Street 1:3 WASHINGTON CIR NW
Practice Address - Street 2:SUITE 403
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2356
Practice Address - Country:US
Practice Address - Phone:202-550-2762
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-17
Last Update Date:2016-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1000582103TC0700X
NY68 018233103TC0700X
MD05493103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD05493OtherMARYLAND STATE