Provider Demographics
NPI:1407475817
Name:FISCO, FRANCIS A (LMSW)
Entity Type:Individual
Prefix:MR
First Name:FRANCIS
Middle Name:A
Last Name:FISCO
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 FORT HALE RD
Mailing Address - Street 2:
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06512-3603
Mailing Address - Country:US
Mailing Address - Phone:203-641-6768
Mailing Address - Fax:
Practice Address - Street 1:93 EDWARDS ST
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3933
Practice Address - Country:US
Practice Address - Phone:203-772-1270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-15
Last Update Date:2020-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5033104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker