Provider Demographics
NPI:1447804406
Name:FISH, DONNA (LCSWR)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:LCSWR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:240 W 102ND ST APT 61
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-4997
Mailing Address - Country:US
Mailing Address - Phone:917-535-2839
Mailing Address - Fax:
Practice Address - Street 1:240 W 102ND ST APT 15
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-4924
Practice Address - Country:US
Practice Address - Phone:212-865-2839
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-29
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0384191041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical