Provider Demographics
NPI:1598067118
Name:FISHER, PERCIVAL JR
Entity Type:Individual
Prefix:MR
First Name:PERCIVAL
Middle Name:
Last Name:FISHER
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:920 BELL AVE
Mailing Address - Street 2:
Mailing Address - City:YEADON
Mailing Address - State:PA
Mailing Address - Zip Code:19050-3705
Mailing Address - Country:US
Mailing Address - Phone:215-983-8720
Mailing Address - Fax:215-857-0815
Practice Address - Street 1:920 BELL AVE
Practice Address - Street 2:
Practice Address - City:YEADON
Practice Address - State:PA
Practice Address - Zip Code:19050-3705
Practice Address - Country:US
Practice Address - Phone:215-983-8720
Practice Address - Fax:215-857-0815
Is Sole Proprietor?:No
Enumeration Date:2010-12-02
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA835931041C0700X
WALW610089961041C0700X
AZ201491041C0700X
ORL130581041C0700X
NJ44SC059387001041C0700X
FLSW186721041C0700X
NCC0145181041C0700X
MN311501041C0700X
WVDP009459471041C0700X
PACW0191681041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical