Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | LC12606 | ME |
NPI | 1003077629 |
---|---|
Provider Name | Ms. Vickie Jacobs Fisher |
First Address | Augusta, ME 04330-5118 |
Second Address | Augusta, ME 04330-5118 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2008 |
Last Update Date | 12/07/2011 |