Provider Demographics
NPI:1043353451
Name:FISKE, SUSAN (MSW,LCSW,BCD)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:
Last Name:FISKE
Suffix:
Gender:F
Credentials:MSW,LCSW,BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1405 N CEDAR CREST BLVD
Mailing Address - Street 2:SUITE 115
Mailing Address - City:ALLENTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18104-2308
Mailing Address - Country:US
Mailing Address - Phone:610-432-0509
Mailing Address - Fax:
Practice Address - Street 1:1405 N CEDAR CREST BLVD
Practice Address - Street 2:SUITE 115
Practice Address - City:ALLENTOWN
Practice Address - State:PA
Practice Address - Zip Code:18104-2308
Practice Address - Country:US
Practice Address - Phone:610-432-0509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW-001275-L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical