Provider Demographics
NPI:1487060224
Name:FLEISCHER-BROWN, AMY (MA-LISW)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:FLEISCHER-BROWN
Suffix:
Gender:F
Credentials:MA-LISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3931 TRUEMAN BLVD
Mailing Address - Street 2:
Mailing Address - City:HILLIARD
Mailing Address - State:OH
Mailing Address - Zip Code:43026-2495
Mailing Address - Country:US
Mailing Address - Phone:614-664-3595
Mailing Address - Fax:614-929-3615
Practice Address - Street 1:3931 TRUEMAN BLVD
Practice Address - Street 2:
Practice Address - City:HILLIARD
Practice Address - State:OH
Practice Address - Zip Code:43026-2495
Practice Address - Country:US
Practice Address - Phone:614-664-3595
Practice Address - Fax:614-929-3615
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2014-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH13036371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1083905830Medicaid
OH1083905830Medicare NSC
OH1083905830Medicaid