Provider Demographics
NPI:1336284496
Name:FISHER, ANDREA MATTISON (PSYD)
Entity Type:Individual
Prefix:
First Name:ANDREA
Middle Name:MATTISON
Last Name:FISHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ANDREA
Other - Middle Name:POLLY
Other - Last Name:MATTISON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:4600 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 223
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-5728
Mailing Address - Country:US
Mailing Address - Phone:202-725-6019
Mailing Address - Fax:877-700-3485
Practice Address - Street 1:4600 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 223
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-5728
Practice Address - Country:US
Practice Address - Phone:202-725-6019
Practice Address - Fax:877-700-3485
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0810003785103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical