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General NPI Number Information
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NPI Number | 1295040657
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Entity Type | Individual
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Provider Name | YESHAYA FISHMAN LCSW
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Gender | Male
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Dates
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Enumeration Date | 08/10/2010
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Last Update Date | 06/01/2021
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Provider Practice Location Address
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Address Line | 64 CLEAR STREAM RD
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City | LAKEWOOD
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State | NJ
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Zip | 08701-2312
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Country | US
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Telephone | 848-525-3526
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Fax |
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Provider Business Mailing Address
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Address Line | 15 PONDEROSA DR
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City | LAKEWOOD
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State | NJ
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Zip | 08701-5151
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Country | US
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Telephone | 848-525-3526
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 44SC05510900
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License Number State | NJ
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