Healthcare Provider Details

I. General information

NPI: 1346788478
Provider Name (Legal Business Name): LISA HLEWICKI LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: LISA FASANELLA

II. Dates (important events)

Enumeration Date: 02/09/2017
Last Update Date: 01/15/2025
Certification Date: 01/15/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HORIZON CENTER BLVD.
HAMILTON NJ
08691
US

IV. Provider business mailing address

200 HORIZON CENTER BLVD.
HAMILTON NJ
08691
US

V. Phone/Fax

Practice location:
  • Phone: 609-249-7073
  • Fax:
Mailing address:
  • Phone: 609-249-7073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10327
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number37PC00725400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: