Provider Demographics
NPI:1891922738
Name:BALABAN FISHER, ALANA MIRIAM (PHD)
Entity Type:Individual
Prefix:
First Name:ALANA
Middle Name:MIRIAM
Last Name:BALABAN FISHER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ALANA
Other - Middle Name:MIRIAM
Other - Last Name:BALABAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:764 PALISADE AVE STE 1F
Mailing Address - Street 2:
Mailing Address - City:TEANECK
Mailing Address - State:NJ
Mailing Address - Zip Code:07666-3129
Mailing Address - Country:US
Mailing Address - Phone:201-490-9675
Mailing Address - Fax:
Practice Address - Street 1:764 PALISADE AVE STE 1F
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3129
Practice Address - Country:US
Practice Address - Phone:201-490-9675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-18
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016605-1103TB0200X, 103TC0700X, 103TH0004X
NJ35SI00486300103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth