Provider Demographics
NPI:1346457702
Name:FISHLEDER, DEBRA D (PC)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:D
Last Name:FISHLEDER
Suffix:
Gender:F
Credentials:PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29325 CHAGRIN BLVD
Mailing Address - Street 2:SUITE NUMBER 102
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44122-4600
Mailing Address - Country:US
Mailing Address - Phone:216-650-1225
Mailing Address - Fax:216-831-3558
Practice Address - Street 1:29325 CHAGRIN BLVD
Practice Address - Street 2:SUITE NUMBER 102
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44122-4600
Practice Address - Country:US
Practice Address - Phone:216-650-1225
Practice Address - Fax:216-831-3558
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC8257101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health