Provider Demographics
NPI:1275146821
Name:FISHER, ELENA VICTORIA (LSW)
Entity Type:Individual
Prefix:
First Name:ELENA
Middle Name:VICTORIA
Last Name:FISHER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1455 S 4TH ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43207-1011
Mailing Address - Country:US
Mailing Address - Phone:614-444-0800
Mailing Address - Fax:614-444-1036
Practice Address - Street 1:1455 S 4TH ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43207-1011
Practice Address - Country:US
Practice Address - Phone:614-444-0800
Practice Address - Fax:614-444-1036
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-24
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.1904326104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker