Provider Demographics
NPI:1669506119
Name:FISHER, RICHARD L (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:L
Last Name:FISHER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 TILLSON AVE STE 213
Mailing Address - Street 2:
Mailing Address - City:ROCKLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04841-3448
Mailing Address - Country:US
Mailing Address - Phone:207-596-0109
Mailing Address - Fax:207-594-0901
Practice Address - Street 1:120 TILLSON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ROCKLAND
Practice Address - State:ME
Practice Address - Zip Code:04841-3451
Practice Address - Country:US
Practice Address - Phone:207-596-0109
Practice Address - Fax:207-594-0901
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2018-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPS611103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ME213450000OtherMAINECARE PROVIDER ID
ME5033044Medicare UPIN
ME003317Medicare UPIN