Provider Demographics
NPI:1003164047
Name:FISCH-LEWIS, DEBORAH KAREN
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:KAREN
Last Name:FISCH-LEWIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DEBORAH
Other - Middle Name:K
Other - Last Name:LEWIS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:101 ELMWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-6146
Mailing Address - Country:US
Mailing Address - Phone:607-339-1479
Mailing Address - Fax:
Practice Address - Street 1:101 ELMWOOD AVE
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-6146
Practice Address - Country:US
Practice Address - Phone:607-339-1479
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-23
Last Update Date:2014-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY090012104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker