Provider Demographics
NPI:1235151580
Name:FISHER, JENNETTE (LMSW)
Entity Type:Individual
Prefix:MS
First Name:JENNETTE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2908 PALO VERDE DR NE
Mailing Address - Street 2:APT C-1
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87112-2103
Mailing Address - Country:US
Mailing Address - Phone:505-934-1001
Mailing Address - Fax:
Practice Address - Street 1:6900 GREGORY CT NE
Practice Address - Street 2:
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87144-8482
Practice Address - Country:US
Practice Address - Phone:505-771-2872
Practice Address - Fax:505-771-2873
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMM-05608104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker