Provider Demographics
NPI:1629280045
Name:FISHER, NADEEN KAREN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NADEEN
Middle Name:KAREN
Last Name:FISHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NADEEN
Other - Middle Name:WOLFF
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:729 N VALLEY DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3708
Mailing Address - Country:US
Mailing Address - Phone:818-326-4671
Mailing Address - Fax:805-496-5379
Practice Address - Street 1:18546 SHERMAN WAY
Practice Address - Street 2:SUITE 202
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-4117
Practice Address - Country:US
Practice Address - Phone:818-326-4671
Practice Address - Fax:805-496-5379
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12207103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY122070Medicaid