Provider Demographics
NPI:1366860710
Name:FISHER, PAMELA (LMSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
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 1:80 EDINBURGH RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-1736
Mailing Address - Country:US
Mailing Address - Phone:845-381-4056
Mailing Address - Fax:
Practice Address - Street 1:2834 ROUTE 17M
Practice Address - Street 2:
Practice Address - City:NEW HAMPTON
Practice Address - State:NY
Practice Address - Zip Code:10958-5011
Practice Address - Country:US
Practice Address - Phone:845-374-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-02
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0107451041C0700X
NY091562104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical