Provider Demographics
NPI:1912914672
Name:FISHLER, MITCHELL EVAN (LMSW)
Entity Type:Individual
Prefix:
First Name:MITCHELL
Middle Name:EVAN
Last Name:FISHLER
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 LAKEVIEW DRIVE
Mailing Address - Street 2:
Mailing Address - City:KIAMESHA LAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12751
Mailing Address - Country:US
Mailing Address - Phone:845-791-5926
Mailing Address - Fax:
Practice Address - Street 1:4551 RTE 55
Practice Address - Street 2:
Practice Address - City:SWAN LAKE
Practice Address - State:NY
Practice Address - Zip Code:12783
Practice Address - Country:US
Practice Address - Phone:885-292-6880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY069015104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker