Provider Demographics
NPI:1578614699
Name:FISHER, JANE M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JANE
Middle Name:M
Last Name:FISHER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 SULLYS TRL
Mailing Address - Street 2:MEADOWGATE BLDG. 10
Mailing Address - City:PITTSFORD
Mailing Address - State:NY
Mailing Address - Zip Code:14534-4552
Mailing Address - Country:US
Mailing Address - Phone:585-586-8550
Mailing Address - Fax:585-586-8603
Practice Address - Street 1:101 SULLYS TRL
Practice Address - Street 2:MEADOWGATE BLDG. 10
Practice Address - City:PITTSFORD
Practice Address - State:NY
Practice Address - Zip Code:14534-4552
Practice Address - Country:US
Practice Address - Phone:585-586-8550
Practice Address - Fax:585-586-8603
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR052776-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY7181397OtherAETNA PROVIDER