Provider Demographics
NPI:1720152705
Name:FISHER, JOSEPH L (LICSW)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:L
Last Name:FISHER
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 FRONT STREET
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:NH
Mailing Address - Zip Code:03833
Mailing Address - Country:US
Mailing Address - Phone:603-778-0505
Mailing Address - Fax:603-772-6761
Practice Address - Street 1:24 FRONT STREET
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:NH
Practice Address - Zip Code:03833
Practice Address - Country:US
Practice Address - Phone:603-778-0505
Practice Address - Fax:603-772-6761
Is Sole Proprietor?:No
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30007060Medicaid
NH30007060Medicaid