Healthcare Provider Details

I. General information

NPI: 1700579828
Provider Name (Legal Business Name): ELISA GIRARD FIFER LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/02/2023
Last Update Date: 06/02/2023
Certification Date: 06/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2940 E PARK AVE STE 1A
TALLAHASSEE FL
32301-3446
US

IV. Provider business mailing address

1064 KINGDOM DR
TALLAHASSEE FL
32311-1222
US

V. Phone/Fax

Practice location:
  • Phone: 850-404-2285
  • Fax:
Mailing address:
  • Phone: 850-556-5709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW6571
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: