=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508637380
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | ALISSA M FISHER LPC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/11/2024
-----------------------------------------------------
Last Update Date | 01/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2053 ROUTE 542
-----------------------------------------------------
City | TUCKERTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08087-3421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-384-0088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2053 ROUTE 542
-----------------------------------------------------
City | TUCKERTON
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 08087-3421
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 609-384-0088
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 37PC00983900
-----------------------------------------------------
License Number State | NJ
-----------------------------------------------------