Provider Demographics
NPI:1922849926
Name:FISH, JANE DEERING
Entity type:Individual
Prefix:
First Name:JANE
Middle Name:DEERING
Last Name:FISH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 716
Mailing Address - Street 2:
Mailing Address - City:BARTON
Mailing Address - State:VT
Mailing Address - Zip Code:05822-0716
Mailing Address - Country:US
Mailing Address - Phone:802-751-5367
Mailing Address - Fax:
Practice Address - Street 1:209 VETERANS AVE
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:VT
Practice Address - Zip Code:05855-5521
Practice Address - Country:US
Practice Address - Phone:802-334-7921
Practice Address - Fax:802-334-1618
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-04
Last Update Date:2024-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical