MEDICARE: MRS. LISA C. FASSETT LPC

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	101YP2500X	Professional Counselor	37AC00060300	NJ

General Provider Information

NPI Number	:	1912208786
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LISA C. FASSETT LPC

Provider Business Mailing Address
First Line	:	927 LIBERTY ST
Second Line	:
City	:	BELVIDERE
State	:	NJ
Zip	:	07823-2019
Country	:	US
Telephone Number	:	973-868-9648
Fax Number	:

Provider Business Practice Location Address
First Line	:	2591 VINE AVE
Second Line	:
City	:	NAPLES
State	:	FL
Zip	:	34120-5362
Country	:	US
Telephone Number	:	973-868-9648
Fax Number	:

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

Provider Enumeration Date	:	11/10/2010
Last Update Date	:	05/11/2026

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