Provider Demographics
NPI:1073689931
Name:FISHER, ELEANOR RUTH (PSY D)
Entity Type:Individual
Prefix:DR
First Name:ELEANOR
Middle Name:RUTH
Last Name:FISHER
Suffix:
Gender:F
Credentials:PSY D
Other - Prefix:MISS
Other - First Name:ELEANOR
Other - Middle Name:RUTH
Other - Last Name:FINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSY D
Mailing Address - Street 1:16 DEER COVE ST
Mailing Address - Street 2:
Mailing Address - City:LYNN
Mailing Address - State:MA
Mailing Address - Zip Code:01902-3120
Mailing Address - Country:US
Mailing Address - Phone:781-595-1059
Mailing Address - Fax:781-842-0580
Practice Address - Street 1:16 DEER COVE ST
Practice Address - Street 2:
Practice Address - City:LYNN
Practice Address - State:MA
Practice Address - Zip Code:01902-3120
Practice Address - Country:US
Practice Address - Phone:781-595-1059
Practice Address - Fax:781-842-0580
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAP010691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP01069Medicare ID - Type UnspecifiedSOCIAL WORKER