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General NPI Number Information
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NPI Number | 1154979656
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Entity Type | Individual
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Provider Name | BRENDA FISHER
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Gender | Female
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Dates
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Enumeration Date | 08/28/2019
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 240 GLEN COVE RD
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City | GLEN HEAD
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State | NY
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Zip | 11545-2207
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Country | US
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Telephone | 516-659-4891
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Fax |
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Provider Business Mailing Address
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Address Line | 3000 ROYAL CT UNIT 3104
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City | NORTH HILLS
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State | NY
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Zip | 11040-2633
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Country | US
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Telephone | 516-692-5203
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | 013088-1
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License Number State | NY
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