Provider Demographics
NPI:1265977227
Name:FISHER, NICOLE (MSW)
Entity type:Individual
Prefix:MS
First Name:NICOLE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MICHAEL RD
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767-1252
Mailing Address - Country:US
Mailing Address - Phone:774-406-9199
Mailing Address - Fax:
Practice Address - Street 1:190 MICHAEL RD
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767-1252
Practice Address - Country:US
Practice Address - Phone:774-406-9199
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-30
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical