Healthcare Provider Details

I. General information

NPI: 1154524205
Provider Name (Legal Business Name): JAY EDWARD FISHER PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/07/2007
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MING AVE STE 330
BAKERSFIELD CA
93309-4680
US

IV. Provider business mailing address

5500 MING AVE STE 330
BAKERSFIELD CA
93309-4680
US

V. Phone/Fax

Practice location:
  • Phone: 661-827-8833
  • Fax: 661-833-8800
Mailing address:
  • Phone: 661-827-8833
  • Fax: 661-833-8800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY7979
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: