Provider Demographics
NPI:1699040931
Name:FISHMAN, JULIANNE ELIZABETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:JULIANNE
Middle Name:ELIZABETH
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:JULIANNE
Other - Middle Name:ELIZABETH
Other - Last Name:SLITT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:75 MOUNT AUBURN ST
Mailing Address - Street 2:HOLYOKE CENTER, 4TH FLOOR
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:02138-4960
Mailing Address - Country:US
Mailing Address - Phone:617-495-2042
Mailing Address - Fax:617-496-6890
Practice Address - Street 1:75 MOUNT AUBURN ST
Practice Address - Street 2:HOLYOKE CENTER, 4TH FLOOR
Practice Address - City:CAMBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:02138-4960
Practice Address - Country:US
Practice Address - Phone:617-495-2042
Practice Address - Fax:617-496-6890
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-20
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9428103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical