Provider Demographics
NPI:1750831517
Name:FISHER, RACHEL (LMSW)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:RACHEL
Other - Middle Name:
Other - Last Name:SIMEONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW
Mailing Address - Street 1:2970 W MAIN STREET RD
Mailing Address - Street 2:
Mailing Address - City:BATAVIA
Mailing Address - State:NY
Mailing Address - Zip Code:14020-9453
Mailing Address - Country:US
Mailing Address - Phone:585-542-9159
Mailing Address - Fax:
Practice Address - Street 1:1387 FAIRPORT RD
Practice Address - Street 2:SUITE 540
Practice Address - City:FAIRPORT
Practice Address - State:NY
Practice Address - Zip Code:14450-2003
Practice Address - Country:US
Practice Address - Phone:585-542-9159
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-05
Last Update Date:2016-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094469104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker