Provider Demographics
NPI:1851619563
Name:FISHMAN, DANIEL PHILIP (PHD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:PHILIP
Last Name:FISHMAN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:233 HARVARD ST
Mailing Address - Street 2:SUITE 207
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-5069
Mailing Address - Country:US
Mailing Address - Phone:617-429-6414
Mailing Address - Fax:
Practice Address - Street 1:233 HARVARD ST
Practice Address - Street 2:SUITE 207
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5069
Practice Address - Country:US
Practice Address - Phone:617-429-6414
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA9792103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical