Provider Demographics
NPI:1790988327
Name:FISCHMAN, MICHAEL IVAN (LCSW-R)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:IVAN
Last Name:FISCHMAN
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154A HICKS ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2375
Mailing Address - Country:US
Mailing Address - Phone:718-625-4807
Mailing Address - Fax:914-725-9812
Practice Address - Street 1:154A HICKS ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2375
Practice Address - Country:US
Practice Address - Phone:718-625-4807
Practice Address - Fax:914-725-9812
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR034581-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health