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Individual
MR. RANDALL FISHER
Active
Individual
MR. RANDALL FISHER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LICSW
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
1015682
MA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
32270
HNE PROVIDER NUMBER
MA
01
—
543688000
MAGELLAN PROVIDER NUMBER
MA
01
—
PO4602
BCBS INDEMITY NUMBER
MA
01
—
PP0394
BCBS MANAGED CARE NUMBER
MA
Enumeration date
09/27/2006
Last updated
03/26/2013
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