Provider Demographics
NPI:1285855361
Name:FISHER, DELORIS DARLENE (LCSW)
Entity Type:Individual
Prefix:
First Name:DELORIS
Middle Name:DARLENE
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1972 ROSEMARY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SANDWICH
Mailing Address - State:IL
Mailing Address - Zip Code:60548
Mailing Address - Country:US
Mailing Address - Phone:630-424-9365
Mailing Address - Fax:630-424-9368
Practice Address - Street 1:55 W. 22ND STREET
Practice Address - Street 2:SUITE 112
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148
Practice Address - Country:US
Practice Address - Phone:630-424-9365
Practice Address - Fax:630-424-9368
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0043111041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL36-3824479OtherTAX ID NUMBER