Provider Demographics
NPI:1144491333
Name:HART, LISA (LSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:MRS
Other - First Name:LISA
Other - Middle Name:
Other - Last Name:PADGETT
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LSW
Mailing Address - Street 1:PO BOX 1507
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662
Mailing Address - Country:US
Mailing Address - Phone:740-355-8606
Mailing Address - Fax:740-353-1662
Practice Address - Street 1:192 CHESTNUT RIDGE RD
Practice Address - Street 2:
Practice Address - City:WEST UNION
Practice Address - State:OH
Practice Address - Zip Code:45693-9584
Practice Address - Country:US
Practice Address - Phone:740-355-8606
Practice Address - Fax:740-353-1662
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS-0600838101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health