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General NPI Number Information
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NPI Number | 1346625472
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Entity Type | Organization
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Legal Business Name | MIRIAM FISHMAN, PSY.D., LLC
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Dates
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Enumeration Date | 07/30/2015
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Last Update Date | 07/30/2015
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Provider Practice Location Address
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Address Line | 630 VERNON AVE SUITE G
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City | GLENCOE
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State | IL
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Zip | 60022-1681
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Country | US
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Telephone | 847-835-1770
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Fax |
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Provider Business Mailing Address
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Address Line | 545 N DEARBORN ST APT 1908
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City | CHICAGO
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State | IL
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Zip | 60654-2658
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL PSYCHOLOGIST
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Name | MIRIAM FISHMAN
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Credential | PSY.D.
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Telephone | 312-636-9166
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 071.008282
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License Number State | IL
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