Provider Demographics
NPI:1578696472
Name:FISHMAN, ROBERT STEPHEN (PHD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEPHEN
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:PHD
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Other - Credentials:
Mailing Address - Street 1:45 1144 KAM HIGHWAY
Mailing Address - Street 2:SUITE 303 AMERICAN SAVINGS BANK BLDG ROBERT FISHMAN PHD
Mailing Address - City:KANEOHE
Mailing Address - State:HI
Mailing Address - Zip Code:96744
Mailing Address - Country:US
Mailing Address - Phone:808-247-5552
Mailing Address - Fax:808-247-9972
Practice Address - Street 1:45 1144 KAM HIGHWAY
Practice Address - Street 2:SUITE 303 AMERICAN SAVINGS BANK BLDG ROBERT FISHMAN PHD
Practice Address - City:KANEOHE
Practice Address - State:HI
Practice Address - Zip Code:96744
Practice Address - Country:US
Practice Address - Phone:808-247-5552
Practice Address - Fax:808-247-9972
Is Sole Proprietor?:No
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIHAWAII 95103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
192848OtherHMN
HI05260101Medicaid
R17887Medicare UPIN
HI05260101Medicaid