Provider Demographics
NPI:1760556724
Name:FISHMAN, NANCY (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:633 SHEPARDBUSH ST
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-5551
Mailing Address - Country:US
Mailing Address - Phone:248-594-5757
Mailing Address - Fax:248-594-5788
Practice Address - Street 1:111 S OLD WOODWARD AVE
Practice Address - Street 2:SUITE #216
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-6117
Practice Address - Country:US
Practice Address - Phone:248-214-8009
Practice Address - Fax:248-594-5788
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301005925103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist