=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356558662
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FISHER & ASSOCIATES SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/17/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 S VAN DYKE AVE
-----------------------------------------------------
City | AIRMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10901-6412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-504-0979
-----------------------------------------------------
Fax | 845-504-0979
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6 S VAN DYKE AVE
-----------------------------------------------------
City | AIRMONT
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 10901-6412
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 845-504-0979
-----------------------------------------------------
Fax | 845-504-0979
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. PATRICIA MARY FISHER
-----------------------------------------------------
Credential | PH.D.
-----------------------------------------------------
Telephone | 845-504-0979
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 716
-----------------------------------------------------
License Number State | DE
-----------------------------------------------------