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General NPI Number Information
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NPI Number | 1760556724
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Entity Type | Individual
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Provider Name | NANCY FISHMAN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 11/20/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 111 S OLD WOODWARD AVE SUITE #216
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City | BIRMINGHAM
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State | MI
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Zip | 48009-6117
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Country | US
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Telephone | 248-214-8009
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Fax | 248-594-5788
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Provider Business Mailing Address
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Address Line | 633 SHEPARDBUSH ST
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City | BIRMINGHAM
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State | MI
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Zip | 48009-5551
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Country | US
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Telephone | 248-594-5757
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Fax | 248-594-5788
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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 | 6301005925
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License Number State | MI
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