Provider Demographics
NPI:1528391943
Name:FISHMAN, LORI D (PSYD)
Entity Type:Individual
Prefix:
First Name:LORI
Middle Name:D
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 BEDFORD ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-4319
Mailing Address - Country:US
Mailing Address - Phone:617-329-1980
Mailing Address - Fax:
Practice Address - Street 1:33 BEDFORD ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-4319
Practice Address - Country:US
Practice Address - Phone:617-329-1980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA09066103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical