Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 104100000X | Social Worker | 090012 | NY |
NPI | 1003164047 |
---|---|
Provider Name | Deborah Karen Fisch-Lewis |
First Address | Ithaca, NY 14850-6146 |
Second Address | Ithaca, NY 14850-6146 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/08/2012 |
Last Update Date | 21/04/2014 |