Provider Demographics
NPI:1467666529
Name:FISHER, BONNIE LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:BONNIE
Middle Name:LEE
Last Name:FISHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:BONNIE
Other - Middle Name:MICHAELSON
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:54 BOHEMIA LN
Mailing Address - Street 2:
Mailing Address - City:EARLEVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21919-1116
Mailing Address - Country:US
Mailing Address - Phone:410-275-8833
Mailing Address - Fax:
Practice Address - Street 1:1001 S BRADFORD ST
Practice Address - Street 2:SUITE #8
Practice Address - City:DOVER
Practice Address - State:DE
Practice Address - Zip Code:19904-4153
Practice Address - Country:US
Practice Address - Phone:302-734-3639
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD840103TC0700X
DE126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical