Provider Demographics
NPI:1972164663
Name:FISHER, AIDEL (MSED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:AIDEL
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:MSED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1967 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11229-2439
Mailing Address - Country:US
Mailing Address - Phone:347-666-0240
Mailing Address - Fax:
Practice Address - Street 1:177 RIDGE AVE APT B
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-3443
Practice Address - Country:US
Practice Address - Phone:347-666-0240
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-24
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-19-36431103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst