MEDICARE: PETER FOSTER-FISHMAN, 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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1720412711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PETER FOSTER-FISHMAN, PSY.D.

Provider Business Mailing Address
First Line	:	1046 CRESENWOOD RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4120
Country	:	US
Telephone Number	:	517-337-2715
Fax Number	:

Provider Business Practice Location Address
First Line	:	1046 CRESENWOOD RD
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4120
Country	:	US
Telephone Number	:	517-337-2715
Fax Number	:

Authorized Official
Title or Position	:	PYCHOLOGIST
Name	:	PETER FOSTER-FISHMAN
Credential	:	PSY.D.
Telephone Number	:	517-337-2715

Provider Enumeration Date	:	08/26/2013
Last Update Date	:	08/26/2013

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