Provider Demographics
NPI:1760505127
Name:DENNIS F FISHER PH D AND ASSOC.
Entity Type:Organization
Organization Name:DENNIS F FISHER PH D AND ASSOC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:F
Authorized Official - Last Name:FISHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:410-836-7222
Mailing Address - Street 1:2832C CHURCHVILLE RD
Mailing Address - Street 2:
Mailing Address - City:CHURCHVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21028-1620
Mailing Address - Country:US
Mailing Address - Phone:410-836-7222
Mailing Address - Fax:
Practice Address - Street 1:2832C CHURCHVILLE RD
Practice Address - Street 2:
Practice Address - City:CHURCHVILLE
Practice Address - State:MD
Practice Address - Zip Code:21028-1620
Practice Address - Country:US
Practice Address - Phone:410-836-7222
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-09
Last Update Date:2007-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDMD953OtherLIC MD
MDMD953OtherLIC MD