Provider Demographics
NPI:1578628046
Name:FISHMAN, ADELE G (LCSW-R)
Entity Type:Individual
Prefix:MS
First Name:ADELE
Middle Name:G
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:LCSW-R
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Mailing Address - Street 1:16 ROCKLEDGE AVE # 3GI
Mailing Address - Street 2:OSSINING 3GI
Mailing Address - City:OSSINING
Mailing Address - State:NY
Mailing Address - Zip Code:10562-5999
Mailing Address - Country:US
Mailing Address - Phone:914-941-6612
Mailing Address - Fax:914-941-6612
Practice Address - Street 1:16 ROCKLEDGE AVE
Practice Address - Street 2:OSSINING 3GI
Practice Address - City:OSSINING
Practice Address - State:NY
Practice Address - Zip Code:10562-5999
Practice Address - Country:US
Practice Address - Phone:914-941-6612
Practice Address - Fax:914-941-6612
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-26
Last Update Date:2012-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR28007NYSTATE104100000X
NYR28007104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY31989OtherMHN
NYP619798OtherOXFORD
NY7401879OtherGHI
NYNA536OtherEBCBS
NYN46461Medicare UPIN
NYP619798OtherOXFORD