Provider Demographics
NPI:1366432072
Name:FIDDLER, PHOEBE M (LICSW)
Entity type:Individual
Prefix:MS
First Name:PHOEBE
Middle Name:M
Last Name:FIDDLER
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:MS
Other - First Name:PEGGY
Other - Middle Name:
Other - Last Name:FIDDLER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LICSW
Mailing Address - Street 1:103 MASSASOIT ST
Mailing Address - Street 2:
Mailing Address - City:NORTHAMPTON
Mailing Address - State:MA
Mailing Address - Zip Code:01060
Mailing Address - Country:US
Mailing Address - Phone:413-695-7861
Mailing Address - Fax:
Practice Address - Street 1:241 KING ST
Practice Address - Street 2:SUITE 230
Practice Address - City:NORTHAMPTON
Practice Address - State:MA
Practice Address - Zip Code:01060
Practice Address - Country:US
Practice Address - Phone:413-695-7861
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-24
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MALICSW1030571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAFIP21319Medicare ID - Type Unspecified