Provider Demographics
NPI:1487750741
Name:FISH, ALLYSON (LCSW)
Entity type:Individual
Prefix:
First Name:ALLYSON
Middle Name:
Last Name:FISH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 478
Mailing Address - Street 2:
Mailing Address - City:NORTH BERWICK
Mailing Address - State:ME
Mailing Address - Zip Code:03906-0478
Mailing Address - Country:US
Mailing Address - Phone:207-502-5886
Mailing Address - Fax:207-387-7880
Practice Address - Street 1:21 BRADEEN ST STE 204
Practice Address - Street 2:
Practice Address - City:SPRINGVALE
Practice Address - State:ME
Practice Address - Zip Code:04083-1925
Practice Address - Country:US
Practice Address - Phone:207-502-5886
Practice Address - Fax:207-387-7880
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-15
Last Update Date:2025-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MELC119031041C0700X
MELC4293101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME431769499Medicare ID - Type UnspecifiedSERVICING PROVIDER NUMBER