Provider Demographics
NPI:1336131663
Name:FISHER, STEPHEN COBB (PHD)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:COBB
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:87 STONY BROOK RD
Mailing Address - Street 2:
Mailing Address - City:WESTFORD
Mailing Address - State:MA
Mailing Address - Zip Code:01886-1905
Mailing Address - Country:US
Mailing Address - Phone:978-846-1572
Mailing Address - Fax:978-654-6650
Practice Address - Street 1:87 STONY BROOK RD
Practice Address - Street 2:
Practice Address - City:WESTFORD
Practice Address - State:MA
Practice Address - Zip Code:01886-1905
Practice Address - Country:US
Practice Address - Phone:978-846-1572
Practice Address - Fax:978-654-6650
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-23
Last Update Date:2021-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3368103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
1670186OtherPRIVATE HEALTH SYSTEMS
730960OtherTUFTS HMO
5333043OtherHEALTHCARE VALUE MANAGEME
1164138OtherFIRST HEALTH
5656232OtherAETNA
211025OtherMAGELLAN BEHAVIORAL HEALT
W03424OtherBLUE CROSS/BLUE SHIELD
730960OtherTUFTS HMO
095999OtherMANAGED HEALTH NETWORK
5656232OtherAETNA
W03424Medicare UPIN
211025OtherMAGELLAN BEHAVIORAL HEALT