Provider Demographics
NPI:1184689036
Name:FISCHER, LISA COLANGELO (PHD)
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:COLANGELO
Last Name:FISCHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4232 E CACTUS ROAD SUITE 207
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85032
Mailing Address - Country:US
Mailing Address - Phone:602-494-8105
Mailing Address - Fax:602-494-8108
Practice Address - Street 1:4232 E CACTUS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-7615
Practice Address - Country:US
Practice Address - Phone:602-494-8105
Practice Address - Fax:602-494-8108
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3609103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZAZ0618030OtherBCBS
AZ7339627OtherAETNA
AZ7339627OtherAETNA