Provider Demographics
NPI:1710188214
Name:FISCHER, FREDERICK M (PSYD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:M
Last Name:FISCHER
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 1:212 GLEN RD
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-2403
Mailing Address - Country:US
Mailing Address - Phone:314-962-3316
Mailing Address - Fax:314-962-3316
Practice Address - Street 1:16 N GORE AVE STE 209
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63119-2315
Practice Address - Country:US
Practice Address - Phone:314-962-3316
Practice Address - Fax:314-962-3316
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01753103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical