Provider Demographics
NPI:1609303221
Name:FISHER, JISUN (PHD)
Entity Type:Individual
Prefix:DR
First Name:JISUN
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 RUTHERFORD RD UNIT 328
Mailing Address - Street 2:
Mailing Address - City:ALLAMUCHY
Mailing Address - State:NJ
Mailing Address - Zip Code:07820-7015
Mailing Address - Country:US
Mailing Address - Phone:973-531-6079
Mailing Address - Fax:
Practice Address - Street 1:54 MALLARD DR
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-2836
Practice Address - Country:US
Practice Address - Phone:973-531-6079
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-13
Last Update Date:2017-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00574700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist