Individual
LISA JOAN REARDON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LICSW
Contact information
Practice address
415 MICHIGAN AVE NE STE 20, WASHINGTON, DC 20017-4500
(202) 321-3781
Mailing address
415 MICHIGAN AVE NE STE 20, WASHINGTON, DC 20017-4500
(202) 321-3781
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
LC301995
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100032383001
APS PROVIDER #
MD
01
—
593365000
PROVIDER MIS#
MD
01
—
6210-0001
BCBS CARE FIRST
DC
01
—
QI18LJ
CARE FIRST PIN
MD
Enumeration date
07/26/2005
Last updated
05/22/2024
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