Provider Demographics
NPI:1598172884
Name:FISH, ANNE C (LCSW)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:C
Last Name:FISH
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 1:1500 PINE PARK AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-1570
Mailing Address - Country:US
Mailing Address - Phone:732-278-6124
Mailing Address - Fax:732-370-7012
Practice Address - Street 1:1500 PINE PARK AVE
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1570
Practice Address - Country:US
Practice Address - Phone:732-278-6124
Practice Address - Fax:732-370-7012
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055637001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical