Provider Demographics
NPI:1689821274
Name:FISHER, CARLA W (ITDS)
Entity Type:Individual
Prefix:
First Name:CARLA
Middle Name:W
Last Name:FISHER
Suffix:
Gender:F
Credentials:ITDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5045 SERRY LN
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-8858
Mailing Address - Country:US
Mailing Address - Phone:850-994-5181
Mailing Address - Fax:850-983-5053
Practice Address - Street 1:5045 SERRY LN
Practice Address - Street 2:
Practice Address - City:PACE
Practice Address - State:FL
Practice Address - Zip Code:32571-8858
Practice Address - Country:US
Practice Address - Phone:850-994-5181
Practice Address - Fax:850-983-5053
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool