Healthcare Provider Details

I. General information

NPI: 1891604039
Provider Name (Legal Business Name): MRS. AMANDA VIVIAN FISHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2026
Last Update Date: 09/05/2026
Certification Date: 09/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

57 CARROLL ST UNIT 1
MANCHESTER NH
03102-4746
US

IV. Provider business mailing address

57 CARROLL ST UNIT 1
MANCHESTER NH
03102-4746
US

V. Phone/Fax

Practice location:
  • Phone: 603-879-1799
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW2142363
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: