Provider Demographics
NPI:1972685659
Name:FISHER, DAVID A (MFT)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:A
Last Name:FISHER
Suffix:
Gender:M
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1806 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:#4
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94709-2227
Mailing Address - Country:US
Mailing Address - Phone:510-548-1916
Mailing Address - Fax:
Practice Address - Street 1:1806 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:#4
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2227
Practice Address - Country:US
Practice Address - Phone:510-548-1916
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 18845106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist