Healthcare Provider Details

I. General information

NPI: 1366432072
Provider Name (Legal Business Name): PHOEBE M FIDDLER LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PEGGY FIDDLER LICSW

II. Dates (important events)

Enumeration Date: 10/24/2005
Last Update Date: 09/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 KING ST SUITE 230
NORTHAMPTON MA
01060
US

IV. Provider business mailing address

103 MASSASOIT ST
NORTHAMPTON MA
01060
US

V. Phone/Fax

Practice location:
  • Phone: 413-695-7861
  • Fax:
Mailing address:
  • Phone: 413-695-7861
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW103057
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: