Provider Demographics
NPI:1619193273
Name:FISHER, ANDREW BRUCE (PHD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:BRUCE
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 1:237 PARK VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PIEDMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94610-1041
Mailing Address - Country:US
Mailing Address - Phone:510-658-5363
Mailing Address - Fax:510-658-5398
Practice Address - Street 1:5665 COLLEGE AVE
Practice Address - Street 2:SUITE 340A
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94618-1625
Practice Address - Country:US
Practice Address - Phone:510-547-6223
Practice Address - Fax:510-420-0888
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9638103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00PL96380Medicare ID - Type Unspecified