Provider Demographics
NPI:1912990623
Name:CAVIGLIA-FISCHER, DOLORES (LCSW)
Entity type:Individual
Prefix:
First Name:DOLORES
Middle Name:
Last Name:CAVIGLIA-FISCHER
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 1:62 PIERREPONT ST
Mailing Address - Street 2:SUITE 1E
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-2452
Mailing Address - Country:US
Mailing Address - Phone:718-855-8907
Mailing Address - Fax:718-965-1252
Practice Address - Street 1:62 PIERREPONT ST
Practice Address - Street 2:SUITE 1E
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-2452
Practice Address - Country:US
Practice Address - Phone:718-855-8907
Practice Address - Fax:718-965-1252
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0150851041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN92171Medicare UPIN