Provider Demographics
NPI:1295004521
Name:HARTMAN, LISA (LISW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:
Last Name:HARTMAN
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5900 N HIGH ST STE 130
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3956
Mailing Address - Country:US
Mailing Address - Phone:614-450-0894
Mailing Address - Fax:614-645-5065
Practice Address - Street 1:5900 N HIGH ST STE 130
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-3956
Practice Address - Country:US
Practice Address - Phone:614-450-0894
Practice Address - Fax:614-645-5065
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-15
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1168334104100000X
OHI.15001031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH08258Medicaid