MEDICARE: TRACY 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	1041C0700X	Clinical Social Worker	2894	NH
2	1041C0700X	Clinical Social Worker	6801112130	MI
3	1041C0700X	Clinical Social Worker	34009792A	IN

General Provider Information

NPI Number	:	1679348742
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TRACY FISHER LCSW

Provider Business Mailing Address
First Line	:	500 N COMMERCIAL ST STE 502
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03101-1151
Country	:	US
Telephone Number	:	574-213-0787
Fax Number	:

Provider Business Practice Location Address
First Line	:	500 N COMMERCIAL ST STE 502
Second Line	:
City	:	MANCHESTER
State	:	NH
Zip	:	03101-1151
Country	:	US
Telephone Number	:	574-213-0787
Fax Number	:

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

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	10/13/2024

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Directions to “ TRACY FISHER LCSW” Practice Location

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