Provider Demographics
NPI:1649694753
Name:FISHMAN, HENRIETTA (MSW)
Entity type:Individual
Prefix:MRS
First Name:HENRIETTA
Middle Name:
Last Name:FISHMAN
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 1:175 W 72ND ST
Mailing Address - Street 2:APT. 12F-1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-3203
Mailing Address - Country:US
Mailing Address - Phone:212-595-5882
Mailing Address - Fax:
Practice Address - Street 1:175 W 72ND ST
Practice Address - Street 2:APT. 12F-1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-3203
Practice Address - Country:US
Practice Address - Phone:212-595-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-10
Last Update Date:2014-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR008719-1101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health