Provider Demographics
NPI:1629197264
Name:FISHMAN, ROSS (PHD)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:FISHMAN
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 1:20 SOUTHWAY
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-2112
Mailing Address - Country:US
Mailing Address - Phone:914-693-3008
Mailing Address - Fax:914-693-6396
Practice Address - Street 1:7 HOLLAND AVE
Practice Address - Street 2:
Practice Address - City:WHITE PLAINS
Practice Address - State:NY
Practice Address - Zip Code:10603-3317
Practice Address - Country:US
Practice Address - Phone:914-261-8143
Practice Address - Fax:914-683-8054
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004009-1101YA0400X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical