Healthcare Provider Details

I. General information

NPI: 1295004521
Provider Name (Legal Business Name): LISA HARTMAN LISW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 N HIGH ST STE 130
WORTHINGTON OH
43085-3956
US

IV. Provider business mailing address

5900 N HIGH ST STE 130
WORTHINGTON OH
43085-3956
US

V. Phone/Fax

Practice location:
  • Phone: 614-450-0894
  • Fax: 614-645-5065
Mailing address:
  • Phone: 614-450-0894
  • Fax: 614-645-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberS.1168334
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.1500103
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: