Provider Demographics
NPI:1780833137
Name:WUYEK, LISA A (PHD)
Entity type:Individual
Prefix:DR
First Name:LISA
Middle Name:A
Last Name:WUYEK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 WYNDHURST AVE
Mailing Address - Street 2:SUITE 245-D
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21210-2489
Mailing Address - Country:US
Mailing Address - Phone:443-376-5946
Mailing Address - Fax:443-438-3056
Practice Address - Street 1:600 WYNDHURST AVE
Practice Address - Street 2:SUITE 245-D
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21210-2489
Practice Address - Country:US
Practice Address - Phone:443-376-5946
Practice Address - Fax:443-438-3056
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-10
Last Update Date:2013-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04493103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical