MEDICARE: DR. SUSAN JEANNE 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	103TC0700X	Clinical Psychologist	PSY14546	CA

General Provider Information

NPI Number	:	1730117094
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN JEANNE FISHER PSY.D.

Provider Business Mailing Address
First Line	:	10921 WILSHIRE BLVD
Second Line	:	STE 405
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4001
Country	:	US
Telephone Number	:	310-824-7874
Fax Number	:

Provider Business Practice Location Address
First Line	:	10921 WILSHIRE BLVD
Second Line	:	STE 405
City	:	LOS ANGELES
State	:	CA
Zip	:	90024-4001
Country	:	US
Telephone Number	:	310-824-7874
Fax Number	:

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

Provider Enumeration Date	:	06/28/2006
Last Update Date	:	09/22/2016

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