Provider Demographics
NPI:1487304887
Name:WALTERS, CARTRICIA (LSW)
Entity type:Individual
Prefix:MS
First Name:CARTRICIA
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3141 ARLENE ST
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:IN
Mailing Address - Zip Code:46368-3939
Mailing Address - Country:US
Mailing Address - Phone:219-902-1156
Mailing Address - Fax:
Practice Address - Street 1:3141 ARLENE ST
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:IN
Practice Address - Zip Code:46368-3939
Practice Address - Country:US
Practice Address - Phone:219-902-1156
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL150.102602104100000X
IN33008293A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker