Provider Demographics
NPI:1851685341
Name:CALDWELL, LISA ANN (LICSW)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:ANN
Last Name:CALDWELL
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:LISA
Other - Middle Name:A
Other - Last Name:CALDWELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:PO BOX 2604
Mailing Address - Street 2:
Mailing Address - City:VASHON
Mailing Address - State:WA
Mailing Address - Zip Code:98070
Mailing Address - Country:US
Mailing Address - Phone:206-624-0098
Mailing Address - Fax:
Practice Address - Street 1:600 1ST AVENUE
Practice Address - Street 2:SUITE 312
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-2239
Practice Address - Country:US
Practice Address - Phone:206-624-0098
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-02
Last Update Date:2020-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW00005188102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst