Healthcare Provider Details

I. General information

NPI: 1336131663
Provider Name (Legal Business Name): STEPHEN COBB FISHER PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/23/2005
Last Update Date: 03/09/2021
Certification Date: 02/05/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

87 STONY BROOK RD
WESTFORD MA
01886-1905
US

IV. Provider business mailing address

87 STONY BROOK RD
WESTFORD MA
01886-1905
US

V. Phone/Fax

Practice location:
  • Phone: 978-846-1572
  • Fax: 978-654-6650
Mailing address:
  • Phone: 978-846-1572
  • Fax: 978-654-6650

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3368
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: