Provider Demographics
NPI:1205983475
Name:FISH, DAVID JAY (MSW)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:JAY
Last Name:FISH
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29W120 BUTTERFIELD RD STE 104A
Mailing Address - Street 2:
Mailing Address - City:WARRENVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60555-2830
Mailing Address - Country:US
Mailing Address - Phone:630-393-4010
Mailing Address - Fax:630-393-4010
Practice Address - Street 1:29W120 BUTTERFIELD RD STE 104A
Practice Address - Street 2:
Practice Address - City:WARRENVILLE
Practice Address - State:IL
Practice Address - Zip Code:60555-2830
Practice Address - Country:US
Practice Address - Phone:630-393-4010
Practice Address - Fax:630-393-4010
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical