Provider Demographics
NPI:1851458772
Name:FISHER, JANINA (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANINA
Middle Name:
Last Name:FISHER
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 1:23 MAIN ST
Mailing Address - Street 2:2ND FLR
Mailing Address - City:WATERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:02472-4403
Mailing Address - Country:US
Mailing Address - Phone:617-924-4646
Mailing Address - Fax:617-924-3551
Practice Address - Street 1:23 MAIN ST
Practice Address - Street 2:2ND FLR
Practice Address - City:WATERTOWN
Practice Address - State:MA
Practice Address - Zip Code:02472-4403
Practice Address - Country:US
Practice Address - Phone:617-924-4646
Practice Address - Fax:617-924-3551
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA6468103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAW05162OtherBCBS PROVIDER NUMBER
MAW05162OtherBCBS PROVIDER NUMBER