Provider Demographics
NPI:1033216692
Name:FISKE, VERONICA JANE (PHD)
Entity Type:Individual
Prefix:DR
First Name:VERONICA
Middle Name:JANE
Last Name:FISKE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:VERONICA
Other - Middle Name:JANE
Other - Last Name:BOYE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:7901 BROADWAY
Mailing Address - Street 2:MANAGED CARE, D1-01
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-1329
Mailing Address - Country:US
Mailing Address - Phone:718-334-1921
Mailing Address - Fax:718-334-3432
Practice Address - Street 1:82-68 164TH ST
Practice Address - Street 2:AOPC QUEENS HOSPITAL CENTER
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11432-1121
Practice Address - Country:US
Practice Address - Phone:718-883-2970
Practice Address - Fax:718-883-6167
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012364103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00246075Medicaid
NY00246075Medicaid