Healthcare Provider Details

I. General information

NPI: 1548107154
Provider Name (Legal Business Name): LILY FORTIN LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2026
Last Update Date: 05/01/2026
Certification Date: 05/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N CHURCH ST
MOORESTOWN NJ
08057-1245
US

IV. Provider business mailing address

411 BARBY LN
CHERRY HILL NJ
08003-3409
US

V. Phone/Fax

Practice location:
  • Phone: 856-448-4718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: