Provider Demographics
NPI:1255502068
Name:FISHER, ELIZABETH SANTOS (L MFT)
Entity type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:SANTOS
Last Name:FISHER
Suffix:
Gender:F
Credentials:L MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 SAYLOR STREET
Mailing Address - Street 2:
Mailing Address - City:SCHUYLKILL HAVEN
Mailing Address - State:PA
Mailing Address - Zip Code:17972
Mailing Address - Country:US
Mailing Address - Phone:570-385-3941
Mailing Address - Fax:
Practice Address - Street 1:420 SAYLOR ST
Practice Address - Street 2:
Practice Address - City:SCHUYLKILL HAVEN
Practice Address - State:PA
Practice Address - Zip Code:17972-1505
Practice Address - Country:US
Practice Address - Phone:570-385-3941
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMF000742101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor