Provider Demographics
NPI:1043536147
Name:LEDERER, LISA (LMSW)
Entity type:Individual
Prefix:MRS
First Name:LISA
Middle Name:
Last Name:LEDERER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3785 VETERANS DR
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49684-4516
Mailing Address - Country:US
Mailing Address - Phone:231-620-0231
Mailing Address - Fax:231-946-0451
Practice Address - Street 1:3298 VETERANS DR
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-4725
Practice Address - Country:US
Practice Address - Phone:231-715-8466
Practice Address - Fax:231-943-2263
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-14
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801089216101YM0800X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health