Provider Demographics
NPI:1275731457
Name:FISCH, RONALD DAVID (LMHC)
Entity Type:Individual
Prefix:MR
First Name:RONALD
Middle Name:DAVID
Last Name:FISCH
Suffix:
Gender:M
Credentials:LMHC
Other - Prefix:MR
Other - First Name:RONALD
Other - Middle Name:DAVID
Other - Last Name:FISCH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS,LMHC
Mailing Address - Street 1:2685 LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:COOPER CITY
Mailing Address - State:FL
Mailing Address - Zip Code:33026-3671
Mailing Address - Country:US
Mailing Address - Phone:954-432-7663
Mailing Address - Fax:954-432-7663
Practice Address - Street 1:2685 LAKE WAY
Practice Address - Street 2:
Practice Address - City:COOPER CITY
Practice Address - State:FL
Practice Address - Zip Code:33026-3671
Practice Address - Country:US
Practice Address - Phone:954-432-7663
Practice Address - Fax:954-432-7663
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-10
Last Update Date:2008-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH2582101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL769036300Medicaid