Provider Demographics
NPI:1730278813
Name:FISHER, MARA (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:679 NE 76TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33138-5140
Mailing Address - Country:US
Mailing Address - Phone:305-754-7246
Mailing Address - Fax:
Practice Address - Street 1:679 NE 76TH ST
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33138-5140
Practice Address - Country:US
Practice Address - Phone:305-754-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW5648101YM0800X
NYR026176-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health