Provider Demographics
NPI:1598775256
Name:FISHER, STEVEN GLENN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:GLENN
Last Name:FISHER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1770
Mailing Address - Street 2:
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91944-1770
Mailing Address - Country:US
Mailing Address - Phone:619-278-0700
Mailing Address - Fax:619-278-0707
Practice Address - Street 1:7290 NAVAJO RD
Practice Address - Street 2:SUITE 212
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-1629
Practice Address - Country:US
Practice Address - Phone:619-278-0700
Practice Address - Fax:619-278-0707
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-08
Last Update Date:2015-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16754103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical