Healthcare Provider Details

I. General information

NPI: 1003970765
Provider Name (Legal Business Name): JOSEPH E FISHER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 04/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 N DELAWARE AVE 3D
PHILADELPHIA PA
19123-4226
US

IV. Provider business mailing address

151 FRAZER AVE
COLLINGSWOOD NJ
08108-1530
US

V. Phone/Fax

Practice location:
  • Phone: 215-923-8042
  • Fax:
Mailing address:
  • Phone: 856-858-0723
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS008848L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: