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General NPI Number Information
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NPI Number | 1932770922
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Entity Type | Individual
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Provider Name | MATTHEW JESSE FISHMAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 07/09/2021
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Last Update Date | 12/09/2024
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Provider Practice Location Address
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Address Line | 158 W 124TH ST FL 5
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City | NEW YORK
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State | NY
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Zip | 10027-4919
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Country | US
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Telephone | 914-330-6212
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Fax |
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Provider Business Mailing Address
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Address Line | 158 W 124TH ST FL 5
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City | NEW YORK
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State | NY
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Zip | 10027-4919
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Country | US
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Telephone |
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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 | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 098545
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License Number State | NY
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