Healthcare Provider Details

I. General information

NPI: 1346152741
Provider Name (Legal Business Name): LISA MARIE MATTHEWS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/21/2026
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1512 E CARACAS AVE STE 300
HERSHEY PA
17033-1184
US

IV. Provider business mailing address

1512 E CARACAS AVE STE 300
HERSHEY PA
17033-1184
US

V. Phone/Fax

Practice location:
  • Phone: 717-500-6759
  • Fax:
Mailing address:
  • Phone: 717-500-6759
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberAPC002907
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: