Provider Demographics
NPI:1417333758
Name:NIERENBERG FISHMAN, LAURA REBECCA (MA LMFT)
Entity Type:Individual
Prefix:MS
First Name:LAURA
Middle Name:REBECCA
Last Name:NIERENBERG FISHMAN
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:MS
Other - First Name:LAURA
Other - Middle Name:NIERENBERG
Other - Last Name:FISHMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MBA, MA, LMFT
Mailing Address - Street 1:2 LARCH TREE LANE
Mailing Address - Street 2:
Mailing Address - City:WESTPORT
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-246-1998
Mailing Address - Fax:
Practice Address - Street 1:161 EAST AVENUE, SUITE 101
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-246-1998
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-08-10
Last Update Date:2015-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT001642106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist