Provider Demographics
NPI:1427857598
Name:FISHER, CHUCK (LCSW)
Entity type:Individual
Prefix:MR
First Name:CHUCK
Middle Name:
Last Name:FISHER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:MR
Other - First Name:CHARLES
Other - Middle Name:WILLIAMM
Other - Last Name:FISHBEIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:16401 SAN PABLO AVE.
Mailing Address - Street 2:SPC335
Mailing Address - City:SAN PABLO
Mailing Address - State:CA
Mailing Address - Zip Code:94806-1325
Mailing Address - Country:US
Mailing Address - Phone:510-325-5708
Mailing Address - Fax:
Practice Address - Street 1:16401 SAN PABLO AVE.
Practice Address - Street 2:SPC335
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806-1325
Practice Address - Country:US
Practice Address - Phone:510-325-5708
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-11
Last Update Date:2025-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA235971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical