Provider Demographics
NPI:1871710921
Name:FISHER, NIKOLE R (MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:NIKOLE
Middle Name:R
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:MISS
Other - First Name:NIKOLE
Other - Middle Name:R
Other - Last Name:NETTLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:755 W CARMEL DR
Mailing Address - Street 2:212
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5877
Mailing Address - Country:US
Mailing Address - Phone:317-569-4533
Mailing Address - Fax:317-569-1767
Practice Address - Street 1:755 W CARMEL DR
Practice Address - Street 2:212
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5877
Practice Address - Country:US
Practice Address - Phone:317-569-4533
Practice Address - Fax:317-569-1767
Is Sole Proprietor?:No
Enumeration Date:2007-04-19
Last Update Date:2011-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34006204A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200939800AMedicaid
IN200939800AMedicaid