MEDICARE: REBECCA ANN FISHER 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	104100000X	Social Worker
2	1041C0700X	Clinical Social Worker	99954	CA

General Provider Information

NPI Number	:	1104128198
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA ANN FISHER LCSW

Provider Business Mailing Address
First Line	:	2629 OSTLING PL
Second Line	:
City	:	SHASTA LAKE
State	:	CA
Zip	:	96019-2133
Country	:	US
Telephone Number	:	530-953-4373
Fax Number	:

Provider Business Practice Location Address
First Line	:	2629 OSTLING PL
Second Line	:
City	:	SHASTA LAKE
State	:	CA
Zip	:	96019-2133
Country	:	US
Telephone Number	:	530-953-4373
Fax Number	:

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

Provider Enumeration Date	:	11/23/2010
Last Update Date	:	09/18/2023

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