Basic Information
Provider Information | |||||||||
NPI: | 1659654846 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | FRITZ | ||||||||
FirstName: | LISA | ||||||||
MiddleName: | R | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | LCSW | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | WALKER | ||||||||
OtherFirstName: | LISA | ||||||||
OtherMiddleName: | R | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | LCSW | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 540 NORTH DUKE STREET | ||||||||
Address2: | 3RD FLOOR | ||||||||
City: | LANCASTER | ||||||||
State: | PA | ||||||||
PostalCode: | 176022208 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7175603782 | ||||||||
FaxNumber: | 7175603787 | ||||||||
Practice Location | |||||||||
Address1: | 540 NORTH DUKE STREET | ||||||||
Address2: | 3RD FLOOR | ||||||||
City: | LANCASTER | ||||||||
State: | PA | ||||||||
PostalCode: | 176022208 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7175603782 | ||||||||
FaxNumber: | 7175603787 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 09/23/2011 | ||||||||
LastUpdateDate: | 06/30/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 06/30/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | SW128848 | PA | N |   | Behavioral Health & Social Service Providers | Social Worker |   | 1041C0700X | CW019882 | PA | N |   | Behavioral Health & Social Service Providers | Social Worker | Clinical | 104100000X | CW019882 | PA | Y |   | Behavioral Health & Social Service Providers | Social Worker |   |
No ID Information.