Provider Demographics
NPI:1598796948
Name:FISHKIN, GERALD LOREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:GERALD
Middle Name:LOREN
Last Name:FISHKIN
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 1:5855 NAPLES PLAZA
Mailing Address - Street 2:SUITE 303
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90803
Mailing Address - Country:US
Mailing Address - Phone:562-987-1533
Mailing Address - Fax:562-987-5554
Practice Address - Street 1:5855 NAPLES PLAZA
Practice Address - Street 2:SUITE 303
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803
Practice Address - Country:US
Practice Address - Phone:562-987-1533
Practice Address - Fax:562-987-5554
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT3490106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist