Healthcare Provider Details

I. General information

NPI: 1689067720
Provider Name (Legal Business Name): DANIEL FISHMAN PHD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/13/2015
Last Update Date: 12/19/2019
Certification Date: 12/19/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29525 CHAGRIN BLVD STE 380
BEACHWOOD OH
44122-4601
US

IV. Provider business mailing address

23749 WENDOVER DR
BEACHWOOD OH
44122-1537
US

V. Phone/Fax

Practice location:
  • Phone: 216-245-1058
  • Fax:
Mailing address:
  • Phone: 216-245-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TH0004X
TaxonomyHealth Psychologist
License NumberP.07996
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberP.07996
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: