Provider Demographics
NPI:1295849040
Name:KARTIGANER, LISA E'LYN (MSW, LICSW, ACSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:E'LYN
Last Name:KARTIGANER
Suffix:
Gender:F
Credentials:MSW, LICSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2955 80TH AVE SE
Mailing Address - Street 2:SUITE 206
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2973
Mailing Address - Country:US
Mailing Address - Phone:206-323-3400
Mailing Address - Fax:
Practice Address - Street 1:2955 80TH AVE SE
Practice Address - Street 2:SUITE 206
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2973
Practice Address - Country:US
Practice Address - Phone:206-323-3400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW000048941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB40002Medicare ID - Type Unspecified