Provider Demographics
NPI:1871670646
Name:FISHER, LAURA MICHELLE FEDOTOTSZKIN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA MICHELLE
Middle Name:FEDOTOTSZKIN
Last Name:FISHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:LAURA
Other - Middle Name:MICHELLE
Other - Last Name:FEDOTOTSZKIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 HARVARD AVE
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-6238
Mailing Address - Country:US
Mailing Address - Phone:617-934-4744
Mailing Address - Fax:888-252-7990
Practice Address - Street 1:7 HARVARD AVE
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6238
Practice Address - Country:US
Practice Address - Phone:617-934-4744
Practice Address - Fax:800-255-7990
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2019-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301012594103TC0700X
MA8622103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA330001Medicare UPIN