Provider Demographics
NPI:1962963363
Name:FISHER, JUNE ELLEN
Entity type:Individual
Prefix:
First Name:JUNE
Middle Name:ELLEN
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:127 TOWNSHIP LINE RD
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2103
Mailing Address - Country:US
Mailing Address - Phone:717-395-0108
Mailing Address - Fax:
Practice Address - Street 1:50 JAMES BUCHANAN RD
Practice Address - Street 2:
Practice Address - City:THORNDALE
Practice Address - State:PA
Practice Address - Zip Code:19372-1132
Practice Address - Country:US
Practice Address - Phone:610-873-1010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-28
Last Update Date:2019-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126287101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health