=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285493502
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DINA FISHER LMSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/18/2024
-----------------------------------------------------
Last Update Date | 03/18/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3 DORADO DR
-----------------------------------------------------
City | PURCHASE
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10577-1005
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-282-1878
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 34 S BROADWAY
-----------------------------------------------------
City | WHITE PLAINS
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10601-4400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-426-1848
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | 053644
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------