Healthcare Provider Details

I. General information

NPI: 1912914672
Provider Name (Legal Business Name): MITCHELL EVAN FISHLER LMSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4551 RTE 55
SWAN LAKE NY
12783
US

IV. Provider business mailing address

22 LAKEVIEW DRIVE
KIAMESHA LAKE NY
12751
US

V. Phone/Fax

Practice location:
  • Phone: 885-292-6880
  • Fax:
Mailing address:
  • Phone: 845-791-5926
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number069015
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: