Provider Demographics
NPI:1558375063
Name:FISHER, STUART BLAKELY (PHD)
Entity Type:Individual
Prefix:DR
First Name:STUART
Middle Name:BLAKELY
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 MAIN ST
Mailing Address - Street 2:THE CENTER FOR PSYCHOTHERAPY INC
Mailing Address - City:ESSEX
Mailing Address - State:CT
Mailing Address - Zip Code:06426-1100
Mailing Address - Country:US
Mailing Address - Phone:860-767-1517
Mailing Address - Fax:860-767-7703
Practice Address - Street 1:28 MAIN ST
Practice Address - Street 2:THE CENTER FOR PSYCHOTHERAPY INC
Practice Address - City:ESSEX
Practice Address - State:CT
Practice Address - Zip Code:06426-1100
Practice Address - Country:US
Practice Address - Phone:860-767-1517
Practice Address - Fax:860-767-7703
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2008-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CTCT1953103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CTC80001271Medicare ID - Type Unspecified