Provider Demographics
NPI:1942449772
Name:FISHMAN, DEBRA (PSYD)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3630 BUSINESS DR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95820-2163
Mailing Address - Country:US
Mailing Address - Phone:916-734-4291
Mailing Address - Fax:
Practice Address - Street 1:3301 C ST STE 1500
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3371
Practice Address - Country:US
Practice Address - Phone:916-734-7463
Practice Address - Fax:916-734-1500
Is Sole Proprietor?:No
Enumeration Date:2009-02-18
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY22462103TH0004X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical