Provider Demographics
NPI:1366113763
Name:FISHER, LEIGH
Entity type:Individual
Prefix:
First Name:LEIGH
Middle Name:
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 1:38 BIRCH RD
Mailing Address - Street 2:
Mailing Address - City:COPAKE
Mailing Address - State:NY
Mailing Address - Zip Code:12516-1037
Mailing Address - Country:US
Mailing Address - Phone:516-640-1256
Mailing Address - Fax:
Practice Address - Street 1:215 HARRY HOWARD AVE
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:NY
Practice Address - Zip Code:12534-1606
Practice Address - Country:US
Practice Address - Phone:518-828-4132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-24
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0872321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical