Provider Demographics
NPI:1356502082
Name:ARTACHE, LISA M (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:M
Last Name:ARTACHE
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:435 E MAIN ST
Mailing Address - Street 2:P.O. BOX 658
Mailing Address - City:ANSONIA
Mailing Address - State:CT
Mailing Address - Zip Code:06401-1964
Mailing Address - Country:US
Mailing Address - Phone:203-736-2601
Mailing Address - Fax:203-736-2641
Practice Address - Street 1:435 E MAIN ST
Practice Address - Street 2:
Practice Address - City:ANSONIA
Practice Address - State:CT
Practice Address - Zip Code:06401-1964
Practice Address - Country:US
Practice Address - Phone:203-736-2601
Practice Address - Fax:203-736-2641
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0066261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTD400000453Medicare PIN