Provider Demographics
NPI:1437290228
Name:FISK, JUDITH HADLEY (LICSW)
Entity Type:Individual
Prefix:MS
First Name:JUDITH
Middle Name:HADLEY
Last Name:FISK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:HADLEY
Other - Middle Name:
Other - Last Name:FISK
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10 NORTHWOOD DR
Mailing Address - Street 2:402
Mailing Address - City:SUDBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01776-1144
Mailing Address - Country:US
Mailing Address - Phone:978-369-5009
Mailing Address - Fax:
Practice Address - Street 1:191 SUDBURY RD
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-3467
Practice Address - Country:US
Practice Address - Phone:978-369-2208
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-12
Last Update Date:2009-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1065601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical