Healthcare Provider Details

I. General information

NPI: 1912208786
Provider Name (Legal Business Name): LISA C. FASSETT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/10/2010
Last Update Date: 05/11/2026
Certification Date: 05/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2591 VINE AVE
NAPLES FL
34120-5362
US

IV. Provider business mailing address

927 LIBERTY ST
BELVIDERE NJ
07823-2019
US

V. Phone/Fax

Practice location:
  • Phone: 973-868-9648
  • Fax:
Mailing address:
  • Phone: 973-868-9648
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37AC00060300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: