Basic Information
| Provider Information | |||||||||
| NPI: | 1851356794 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | LINDA | ||||||||
| MiddleName: | JETER | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LMHC | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | JETER | ||||||||
| OtherFirstName: | LINDA | ||||||||
| OtherMiddleName: | JOYCE | ||||||||
| OtherNamePrefix: | MISS | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LMHC | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 12010 85TH AVE | ||||||||
| Address2: | APARTMENT 4I | ||||||||
| City: | KEW GARDENS | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114153236 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184412475 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | DEPARTMENT OF VETERANS AFFAIRS EXTENDED CARE CNTR | ||||||||
| Address2: | 179 ST & LINDEN BLVD, DOMICILIARY #88 | ||||||||
| City: | JAMAICA | ||||||||
| State: | NY | ||||||||
| PostalCode: | 114250001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7185261000 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 000627 | NY | X | Behavioral Health & Social Service Providers | Counselor | Mental Health | 225C00000X | 000627 | NY | X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor |
No ID Information.