Provider Demographics
NPI:1053834937
Name:FISHER, ALBAN GEORGE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ALBAN
Middle Name:GEORGE
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2421 W ARDMORE AVE # 3
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-5007
Mailing Address - Country:US
Mailing Address - Phone:773-663-6597
Mailing Address - Fax:
Practice Address - Street 1:3239 GROVE AVE STE 2
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:IL
Practice Address - Zip Code:60402-3469
Practice Address - Country:US
Practice Address - Phone:773-663-6597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-21
Last Update Date:2017-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL180003915101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional