Provider Demographics
NPI:1073958484
Name:FISHMAN, JAMES M (MSW, LCSW, CGP)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:M
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:MSW, LCSW, CGP
Other - Prefix:MR
Other - First Name:JAMES
Other - Middle Name:MARSHALL
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MSW LCSW, CGP
Mailing Address - Street 1:414 GOUGH ST STE 3
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94102-4474
Mailing Address - Country:US
Mailing Address - Phone:415-359-1407
Mailing Address - Fax:
Practice Address - Street 1:414 GOUGH ST STE 3
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94102-4474
Practice Address - Country:US
Practice Address - Phone:415-359-1407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-30
Last Update Date:2013-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 115671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical