Provider Demographics
NPI:1043325954
Name:SCHACHTER, LISA SHANE (LICSW)
Entity type:Individual
Prefix:MS
First Name:LISA
Middle Name:SHANE
Last Name:SCHACHTER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 WATERMAN ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02906-2126
Mailing Address - Country:US
Mailing Address - Phone:401-751-1923
Mailing Address - Fax:401-272-0507
Practice Address - Street 1:144 WATERMAN ST
Practice Address - Street 2:SUITE 4
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02906-2126
Practice Address - Country:US
Practice Address - Phone:401-751-1923
Practice Address - Fax:401-272-0507
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2020-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW01064104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker