Provider Demographics
NPI:1083372858
Name:FISHER, ROB MICHAEL
Entity Type:Individual
Prefix:
First Name:ROB
Middle Name:MICHAEL
Last Name:FISHER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:91 OLD COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:WESTON
Mailing Address - State:VT
Mailing Address - Zip Code:05161-6204
Mailing Address - Country:US
Mailing Address - Phone:415-269-1186
Mailing Address - Fax:
Practice Address - Street 1:621 EUCALYPTUS WAY
Practice Address - Street 2:
Practice Address - City:MILL VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94941-3905
Practice Address - Country:US
Practice Address - Phone:415-269-1186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-29
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty