MEDICARE: JENNIFER ELIZABETH FISHER LMFT

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	106H00000X	Marriage & Family Therapist	110764	CA

General Provider Information

NPI Number	:	1972990505
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELIZABETH FISHER LMFT

Provider Business Mailing Address
First Line	:	3725 TALBOT ST STE F
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2052
Country	:	US
Telephone Number	:	619-252-7429
Fax Number	:

Provider Business Practice Location Address
First Line	:	3725 TALBOT ST STE F
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92106-2052
Country	:	US
Telephone Number	:	619-252-7429
Fax Number	:

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

Provider Enumeration Date	:	04/21/2015
Last Update Date	:	05/11/2020

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