Provider Demographics
NPI:1851356794
Name:FISHER, LINDA JETER (LMHC)
Entity Type:Individual
Prefix:MS
First Name:LINDA
Middle Name:JETER
Last Name:FISHER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MISS
Other - First Name:LINDA
Other - Middle Name:JOYCE
Other - Last Name:JETER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHC
Mailing Address - Street 1:12010 85TH AVE
Mailing Address - Street 2:APARTMENT 4I
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-3236
Mailing Address - Country:US
Mailing Address - Phone:718-441-2475
Mailing Address - Fax:
Practice Address - Street 1:DEPARTMENT OF VETERANS AFFAIRS EXTENDED CARE CNTR
Practice Address - Street 2:179 ST & LINDEN BLVD, DOMICILIARY #88
Practice Address - City:JAMAICA
Practice Address - State:NY
Practice Address - Zip Code:11425-0001
Practice Address - Country:US
Practice Address - Phone:718-526-1000
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000627101YM0800X, 225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor