Provider Demographics
NPI:1730910209
Name:FITCH, INDA VICTORIA (LMSW)
Entity type:Individual
Prefix:
First Name:INDA
Middle Name:VICTORIA
Last Name:FITCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:INDA
Other - Middle Name:VICTORIA
Other - Last Name:GILLETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1418
Mailing Address - Country:US
Mailing Address - Phone:607-422-7215
Mailing Address - Fax:
Practice Address - Street 1:26 SHERMAN AVE
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1418
Practice Address - Country:US
Practice Address - Phone:607-422-7215
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-08
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY116551104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker