Provider Demographics
NPI:1861868929
Name:JILL FISCHBERG, LMHC
Entity type:Organization
Organization Name:JILL FISCHBERG, LMHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:FISCHBERG
Authorized Official - Suffix:
Authorized Official - Credentials:LMHC
Authorized Official - Phone:941-468-4567
Mailing Address - Street 1:6170 53RD AVE E
Mailing Address - Street 2:
Mailing Address - City:BRADENTON
Mailing Address - State:FL
Mailing Address - Zip Code:34203-9721
Mailing Address - Country:US
Mailing Address - Phone:941-468-4567
Mailing Address - Fax:941-621-6226
Practice Address - Street 1:6170 53RD AVE E
Practice Address - Street 2:
Practice Address - City:BRADENTON
Practice Address - State:FL
Practice Address - Zip Code:34203-9721
Practice Address - Country:US
Practice Address - Phone:941-468-4567
Practice Address - Fax:941-621-6226
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-12
Last Update Date:2015-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH10788101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty