Provider Demographics
NPI:1285759118
Name:FISHER, CORRINE TAFOYA (ACSW LCSW)
Entity type:Individual
Prefix:MRS
First Name:CORRINE
Middle Name:TAFOYA
Last Name:FISHER
Suffix:
Gender:F
Credentials:ACSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 12TH AVE SO
Mailing Address - Street 2:SUITE 103
Mailing Address - City:NAMPA
Mailing Address - State:ID
Mailing Address - Zip Code:83651
Mailing Address - Country:US
Mailing Address - Phone:208-461-3720
Mailing Address - Fax:208-461-1787
Practice Address - Street 1:16 12TH AVE SO
Practice Address - Street 2:SUITE 103
Practice Address - City:NAMPA
Practice Address - State:ID
Practice Address - Zip Code:83651
Practice Address - Country:US
Practice Address - Phone:208-461-3720
Practice Address - Fax:208-461-1787
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW5621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID807292400Medicaid
8M061OtherBLUE SHIELD
IDE5428OtherBLUE CROSS