Provider Demographics
NPI:1134812480
Name:FISHER, JESSICA MEGAN
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:MEGAN
Last Name:FISHER
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 1:12528 WAR ADMIRAL WAY
Mailing Address - Street 2:
Mailing Address - City:NORTH POTOMAC
Mailing Address - State:MD
Mailing Address - Zip Code:20878-3704
Mailing Address - Country:US
Mailing Address - Phone:240-848-8840
Mailing Address - Fax:
Practice Address - Street 1:656 QUINCE ORCHARD RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20878-1409
Practice Address - Country:US
Practice Address - Phone:301-233-5020
Practice Address - Fax:240-912-9564
Is Sole Proprietor?:No
Enumeration Date:2023-06-01
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30075104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker