MEDICARE: ELIZABETH FISHMAN PSY.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	071-006708	IL

General Provider Information

NPI Number	:	1285998120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH FISHMAN PSY.D.

Provider Business Mailing Address
First Line	:	950 N WESTERN AVE STE 1A
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-1734
Country	:	US
Telephone Number	:	847-234-0534
Fax Number	:

Provider Business Practice Location Address
First Line	:	950 N WESTERN AVE STE 1A
Second Line	:
City	:	LAKE FOREST
State	:	IL
Zip	:	60045-1734
Country	:	US
Telephone Number	:	847-234-0534
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2012
Last Update Date	:	06/26/2012

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