Provider Demographics
NPI:1649394511
Name:FISHMAN, DIANE M (PHD)
Entity Type:Individual
Prefix:DR
First Name:DIANE
Middle Name:M
Last Name:FISHMAN
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 1:968 FARMINGTON AVE
Mailing Address - Street 2:SUITES 201-203
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06107-2172
Mailing Address - Country:US
Mailing Address - Phone:860-231-9492
Mailing Address - Fax:
Practice Address - Street 1:968 FARMINGTON AVE
Practice Address - Street 2:SUITES 201-203
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06107-2172
Practice Address - Country:US
Practice Address - Phone:860-231-9492
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002037103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical