Provider Demographics
NPI:1780193151
Name:FISHER, ANITA ROSE (RBT)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:ROSE
Last Name:FISHER
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1509 E COLONIAL DR STE 300
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-4729
Mailing Address - Country:US
Mailing Address - Phone:407-218-4371
Mailing Address - Fax:407-218-4304
Practice Address - Street 1:500 E COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-4510
Practice Address - Country:US
Practice Address - Phone:407-218-4340
Practice Address - Fax:407-218-4303
Is Sole Proprietor?:No
Enumeration Date:2017-09-28
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL022166900Medicaid