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General NPI Number Information
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NPI Number | 1376819334
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Entity Type | Individual
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Provider Name | ROBERTA MARIE FISH LCSW
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Gender | Female
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Dates
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Enumeration Date | 03/23/2012
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Last Update Date | 03/23/2012
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Provider Practice Location Address
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Address Line | 1642 N VOLUSIA AVE SUITE 203
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City | ORANGE CITY
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State | FL
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Zip | 32763-3842
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Country | US
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Telephone | 386-456-0008
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Fax |
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Provider Business Mailing Address
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Address Line | 696 TORCHWOOD DR
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City | DELAND
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State | FL
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Zip | 32724-9462
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Country | US
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Telephone | 407-719-4490
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW6448
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License Number State | FL
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