Provider Demographics
NPI:1003034307
Name:FISHMAN, LAURA DANIELLE (LMSW, ACSW)
Entity Type:Individual
Prefix:
First Name:LAURA
Middle Name:DANIELLE
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:LMSW, ACSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 W LONG LAKE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BLOOMFIELD HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48304-2769
Mailing Address - Country:US
Mailing Address - Phone:248-686-0339
Mailing Address - Fax:248-220-3322
Practice Address - Street 1:74 W LONG LAKE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:BLOOMFIELD HILLS
Practice Address - State:MI
Practice Address - Zip Code:48304-2769
Practice Address - Country:US
Practice Address - Phone:248-686-0339
Practice Address - Fax:248-220-3322
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-23
Last Update Date:2013-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010776901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical