Provider Demographics
NPI:1376708800
Name:FISHBEIN, JOHN (PHD)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:FISHBEIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4020 MOORPARK AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95117-4102
Mailing Address - Country:US
Mailing Address - Phone:408-247-9914
Mailing Address - Fax:408-247-9958
Practice Address - Street 1:4020 MOORPARK AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95117-4102
Practice Address - Country:US
Practice Address - Phone:408-247-9914
Practice Address - Fax:408-247-9958
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-24
Last Update Date:2008-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM6997106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist