Healthcare Provider Details

I. General information

NPI: 1750772794
Provider Name (Legal Business Name): YON FISHER LCSW-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/12/2015
Last Update Date: 02/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10630 LITTLE PATUXENT PKWY SUITE 209
COLUMBIA MD
21044-3264
US

IV. Provider business mailing address

10630 LITTLE PATUXENT PKWY SUITE 209
COLUMBIA MD
21044-3264
US

V. Phone/Fax

Practice location:
  • Phone: 410-740-8066
  • Fax: 410-740-8068
Mailing address:
  • Phone: 410-740-8066
  • Fax: 410-740-8068

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number11046
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: