Provider Demographics
NPI:1346492444
Name:FISHER, MOLLY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:
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 1:1623 3RD AVE APT 31K
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3697
Mailing Address - Country:US
Mailing Address - Phone:401-864-1728
Mailing Address - Fax:
Practice Address - Street 1:1133 BROADWAY
Practice Address - Street 2:SUITE 1101
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-7903
Practice Address - Country:US
Practice Address - Phone:917-525-3731
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-21
Last Update Date:2022-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077754-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical