Provider Demographics
NPI:1760037907
Name:FISHER, MARICELA (BCBA)
Entity Type:Individual
Prefix:
First Name:MARICELA
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74 CREEKFORD XING
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:GA
Mailing Address - Zip Code:30157-2591
Mailing Address - Country:US
Mailing Address - Phone:832-205-5946
Mailing Address - Fax:281-710-0889
Practice Address - Street 1:74 CREEKFORD XING
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:GA
Practice Address - Zip Code:30157-2591
Practice Address - Country:US
Practice Address - Phone:832-205-5946
Practice Address - Fax:281-710-0889
Is Sole Proprietor?:No
Enumeration Date:2019-08-05
Last Update Date:2022-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst