Provider Demographics
NPI:1518465269
Name:FISHOFF, MONTGOMERY (LMSW)
Entity Type:Individual
Prefix:
First Name:MONTGOMERY
Middle Name:
Last Name:FISHOFF
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 1:244 MADISON AVE APT 10G
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-2813
Mailing Address - Country:US
Mailing Address - Phone:203-216-5830
Mailing Address - Fax:
Practice Address - Street 1:147 FRONT ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-1154
Practice Address - Country:US
Practice Address - Phone:917-543-1011
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-29
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY095557104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker