Healthcare Provider Details

I. General information

NPI: 1154802486
Provider Name (Legal Business Name): CANDICE FISHMAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/24/2018
Last Update Date: 08/24/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 STAGE RD
MONROE NY
10950-3512
US

IV. Provider business mailing address

101 STAGE RD
MONROE NY
10950-3512
US

V. Phone/Fax

Practice location:
  • Phone: 845-827-6227
  • Fax:
Mailing address:
  • Phone: 845-827-6227
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: