MEDICARE: LISA STEKERT LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor
2	104100000X	Social Worker	6735-S	NV
3	1041C0700X	Clinical Social Worker	87814	CA

General Provider Information

NPI Number	:	1780055590
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LISA STEKERT LCSW

Provider Business Mailing Address
First Line	:	PO BOX 573
Second Line	:
City	:	CARNELIAN BAY
State	:	CA
Zip	:	96140-0573
Country	:	US
Telephone Number	:	530-412-1713
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 NORTH LAKE BLVD
Second Line	:
City	:	TAHOE CITY
State	:	CA
Zip	:	96145-0000
Country	:	US
Telephone Number	:	530-412-1713
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2015
Last Update Date	:	09/26/2023

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