Provider Demographics
NPI:1598140469
Name:FISHER, RABECCA
Entity Type:Individual
Prefix:
First Name:RABECCA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:RABECCA
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7545 OSO BLANCA RD UNIT 2186
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89149-1479
Mailing Address - Country:US
Mailing Address - Phone:702-469-1053
Mailing Address - Fax:
Practice Address - Street 1:7545 OSO BLANCA RD UNIT 2186
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-1479
Practice Address - Country:US
Practice Address - Phone:702-469-1053
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-21
Last Update Date:2020-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVIC-14781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical