Healthcare Provider Details

I. General information

NPI: 1245846773
Provider Name (Legal Business Name): LISA ANN VOLANTE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2020
Last Update Date: 09/21/2020
Certification Date: 09/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3640 VALLEY ROAD
LIBERTY CORNER NJ
07938
US

IV. Provider business mailing address

39 E CLIFF ST
SOMERVILLE NJ
08876-1910
US

V. Phone/Fax

Practice location:
  • Phone: 908-484-7354
  • Fax:
Mailing address:
  • Phone: 732-757-9537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number37PC00531400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: