MEDICARE: REBECCA FISHER PSYD

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	101YM0800X	Mental Health Counselor
2	101YP2500X	Professional Counselor	PC007108	PA
3	103T00000X	Psychologist	PS019175	PA

General Provider Information

NPI Number	:	1851607956
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	REBECCA FISHER PSYD

Provider Business Mailing Address
First Line	:	928 JAYMOR RD STE B150
Second Line	:
City	:	SOUTHAMPTON
State	:	PA
Zip	:	18966-3853
Country	:	US
Telephone Number	:	215-947-8654
Fax Number	:

Provider Business Practice Location Address
First Line	:	390 COMMERCE DR
Second Line	:
City	:	FORT WASHINGTON
State	:	PA
Zip	:	19034-2600
Country	:	US
Telephone Number	:	484-533-7036
Fax Number	:

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

Provider Enumeration Date	:	08/26/2010
Last Update Date	:	12/18/2024

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