Provider Demographics
NPI:1326032798
Name:FLICK, LISA Z (LCSW)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:Z
Last Name:FLICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 PFOUTS ST
Mailing Address - Street 2:
Mailing Address - City:HANOVER TOWNSHIP
Mailing Address - State:PA
Mailing Address - Zip Code:18706-3116
Mailing Address - Country:US
Mailing Address - Phone:570-829-0795
Mailing Address - Fax:
Practice Address - Street 1:5 PFOUTS ST
Practice Address - Street 2:
Practice Address - City:HANOVER TOWNSHIP
Practice Address - State:PA
Practice Address - Zip Code:18706-3116
Practice Address - Country:US
Practice Address - Phone:570-829-0795
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0141111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical