MEDICARE: IRENE FISHER PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TR0400X	Rehabilitation Psychologist	B1-0000294	DE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1000023583	OTHER	DE	DELAWARE PHYSICIANS CARE

General Provider Information

NPI Number	:	1134286016
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	IRENE FISHER PSY.D.

Provider Business Mailing Address
First Line	:	2006 FOULK RD
Second Line	:	SUITE B
City	:	WILMINGTON
State	:	DE
Zip	:	19810-3644
Country	:	US
Telephone Number	:	302-529-8783
Fax Number	:	302-529-7470

Provider Business Practice Location Address
First Line	:	2006 FOULK RD
Second Line	:	SUITE B
City	:	WILMINGTON
State	:	DE
Zip	:	19810-3644
Country	:	US
Telephone Number	:	302-529-8783
Fax Number	:	302-529-7470

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/02/2007
Last Update Date	:	07/08/2007

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