Provider Demographics
NPI:1861554388
Name:FISH, NANCY CAROL (LCSW)
Entity type:Individual
Prefix:MS
First Name:NANCY
Middle Name:CAROL
Last Name:FISH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4-61 IVY LN
Mailing Address - Street 2:
Mailing Address - City:FAIR LAWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07410-1652
Mailing Address - Country:US
Mailing Address - Phone:201-796-8544
Mailing Address - Fax:201-796-3541
Practice Address - Street 1:4-61 IVY LN
Practice Address - Street 2:
Practice Address - City:FAIR LAWN
Practice Address - State:NJ
Practice Address - Zip Code:07410-1652
Practice Address - Country:US
Practice Address - Phone:201-796-8544
Practice Address - Fax:201-796-3541
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC04902200101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health