Provider Demographics
NPI:1629670401
Name:FISCHHOFF, AMELIA (LLMSW)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:
Last Name:FISCHHOFF
Suffix:
Gender:F
Credentials:LLMSW
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:
Other - Last Name:FISCHHOFF
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:818 LINCOLN AVE
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48104-3525
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:818 LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48104-3525
Practice Address - Country:US
Practice Address - Phone:734-417-6070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801097691101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1237337025Medicaid