Provider Demographics
NPI:1487852521
Name:FISCH, CHARLES (MSW)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:
Last Name:FISCH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:
Other - Last Name:FISCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MSW
Mailing Address - Street 1:1623 3RD AVE APT 18F
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-3641
Mailing Address - Country:US
Mailing Address - Phone:917-374-0009
Mailing Address - Fax:
Practice Address - Street 1:425 KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11223-1629
Practice Address - Country:US
Practice Address - Phone:718-787-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-07-10
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017884-R1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02858684Medicaid