Provider Demographics
NPI:1831276963
Name:FISH, CHERYL ANN (LCMHC)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:ANN
Last Name:FISH
Suffix:
Gender:F
Credentials:LCMHC
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:32 PLEASANT ST
Mailing Address - Street 2:VERMONT CHILDREN'S AID SOCIETY, SIMMONS BUILDING
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-1122
Mailing Address - Country:US
Mailing Address - Phone:802-457-3084
Mailing Address - Fax:802-457-3086
Practice Address - Street 1:32 PLEASANT ST
Practice Address - Street 2:VERMONT CHILDREN'S AID SOCIETY, SIMMONS BUILDING
Practice Address - City:WOODSTOCK
Practice Address - State:VT
Practice Address - Zip Code:05091-1122
Practice Address - Country:US
Practice Address - Phone:802-457-3084
Practice Address - Fax:802-457-3086
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NH54101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VT1005524Medicaid