Provider Demographics
NPI:1629229828
Name:FISHER, SHERRY J (MA COUN PSYCH)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:J
Last Name:FISHER
Suffix:
Gender:F
Credentials:MA COUN PSYCH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:135 PIIMAUNA ST
Mailing Address - Street 2:
Mailing Address - City:MAKAWAO
Mailing Address - State:HI
Mailing Address - Zip Code:96768-8869
Mailing Address - Country:US
Mailing Address - Phone:808-205-2482
Mailing Address - Fax:
Practice Address - Street 1:135 PIIMAUNA ST
Practice Address - Street 2:
Practice Address - City:MAKAWAO
Practice Address - State:HI
Practice Address - Zip Code:96768-8869
Practice Address - Country:US
Practice Address - Phone:808-205-2482
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-06
Last Update Date:2015-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
HIMHC-350305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No305S00000XManaged Care OrganizationsPoint of Service