Provider Demographics
NPI:1962599613
Name:FISCHBACH, MONICA (LCPC)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:
Last Name:FISCHBACH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 YARMOUTH RD
Mailing Address - Street 2:
Mailing Address - City:GRAY
Mailing Address - State:ME
Mailing Address - Zip Code:04039-9601
Mailing Address - Country:US
Mailing Address - Phone:207-415-5094
Mailing Address - Fax:207-282-8030
Practice Address - Street 1:333 LINCOLN ST STE 220
Practice Address - Street 2:
Practice Address - City:SACO
Practice Address - State:ME
Practice Address - Zip Code:04072-3113
Practice Address - Country:US
Practice Address - Phone:207-415-5094
Practice Address - Fax:207-282-8030
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2020-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MECC2296101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME292910099Medicaid