Healthcare Provider Details

I. General information

NPI: 1043378615
Provider Name (Legal Business Name): NANCY ROSE FISHER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

64 ELDREDGE ST
NEWTON MA
02458-2017
US

IV. Provider business mailing address

1175 CHESTNUT ST 18
NEWTON UPPER FALLS MA
02464-1358
US

V. Phone/Fax

Practice location:
  • Phone: 617-969-4925
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number106078
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: