Provider Demographics
NPI:1417003468
Name:WITENBERG FISHER, SUSAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:
Last Name:WITENBERG FISHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SUSAN
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:7 BIRCH HILL RD
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12211-2004
Mailing Address - Country:US
Mailing Address - Phone:518-434-6096
Mailing Address - Fax:
Practice Address - Street 1:316 DELAWARE AVE
Practice Address - Street 2:SUITE 222
Practice Address - City:DELMAR
Practice Address - State:NY
Practice Address - Zip Code:12054-1932
Practice Address - Country:US
Practice Address - Phone:518-475-0142
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2008-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007469103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist