Healthcare Provider Details

I. General information

NPI: 1225794464
Provider Name (Legal Business Name): LISA MEDVETZ LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/11/2021
Last Update Date: 11/22/2025
Certification Date: 11/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

213 TRAPPER SPRINGS LN
DRUMS PA
18222-1219
US

IV. Provider business mailing address

213 TRAPPER SPRINGS LN
DRUMS PA
18222-1219
US

V. Phone/Fax

Practice location:
  • Phone: 570-519-8818
  • Fax:
Mailing address:
  • Phone: 570-519-8818
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW024936
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSW138366
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: