Provider Demographics
NPI:1669496444
Name:FISHER, DANIELLE LARA (LCSW)
Entity Type:Individual
Prefix:MS
First Name:DANIELLE
Middle Name:LARA
Last Name:FISHER
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 1:4040 PRESIDENTIAL BLVD
Mailing Address - Street 2:APT 3022
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19131-1727
Mailing Address - Country:US
Mailing Address - Phone:215-694-0115
Mailing Address - Fax:
Practice Address - Street 1:261 GRISSCOM CT
Practice Address - Street 2:
Practice Address - City:MARLTON
Practice Address - State:NJ
Practice Address - Zip Code:08053-2011
Practice Address - Country:US
Practice Address - Phone:973-558-2792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-26
Last Update Date:2023-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052739001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical