Healthcare Provider Details

I. General information

NPI: 1023160777
Provider Name (Legal Business Name): CHRISTOPHER J FICHERA PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7100 WEST CAMINO REAL SUITE # 123
BOCA RATON FL
33433-5510
US

IV. Provider business mailing address

7100 WEST CAMINO REAL SUITE # 123
BOCA RATON FL
33433-5510
US

V. Phone/Fax

Practice location:
  • Phone: 561-395-0243
  • Fax: 561-391-5054
Mailing address:
  • Phone: 561-395-0243
  • Fax: 561-391-5054

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPY4473
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: