Healthcare Provider Details

I. General information

NPI: 1154778165
Provider Name (Legal Business Name): LISA M FISHER MA, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/19/2016
Last Update Date: 05/19/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 MULBERRY STREET SUITE 201
SCRANTON PA
18503
US

IV. Provider business mailing address

300 MULBERRY STREET SUITE 201
SCRANTON PA
18503
US

V. Phone/Fax

Practice location:
  • Phone: 607-372-2018
  • Fax:
Mailing address:
  • Phone: 607-372-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberPC008887
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: