Healthcare Provider Details

I. General information

NPI: 1134995608
Provider Name (Legal Business Name): PATRICIA ANN FICHTER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2023
Last Update Date: 11/27/2023
Certification Date: 11/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 ANGELA LN
BAY SHORE NY
11706-8904
US

IV. Provider business mailing address

28 ANGELA LN
BAY SHORE NY
11706-8904
US

V. Phone/Fax

Practice location:
  • Phone: 516-551-3457
  • Fax: 631-661-3135
Mailing address:
  • Phone: 516-551-3457
  • Fax: 631-661-3135

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number080426-01
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: