Provider Demographics
NPI:1477111318
Name:FISHMAN, KATHERINE (PHD, HSP-P)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:PHD, HSP-P
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:895 STATE FARM RD STE 507
Mailing Address - Street 2:
Mailing Address - City:BOONE
Mailing Address - State:NC
Mailing Address - Zip Code:28607-5432
Mailing Address - Country:US
Mailing Address - Phone:828-263-6287
Mailing Address - Fax:
Practice Address - Street 1:895 STATE FARM RD STE 507
Practice Address - Street 2:
Practice Address - City:BOONE
Practice Address - State:NC
Practice Address - Zip Code:28607-5432
Practice Address - Country:US
Practice Address - Phone:828-263-6287
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-05
Last Update Date:2019-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103T00000X, 103TC1900X
NC5449103TH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling