Provider Demographics
NPI:1255699971
Name:FISHER, ALISA NICOLE (BCBA)
Entity type:Individual
Prefix:
First Name:ALISA
Middle Name:NICOLE
Last Name:FISHER
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10273 ORTON AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-2505
Mailing Address - Country:US
Mailing Address - Phone:310-853-8025
Mailing Address - Fax:310-853-8025
Practice Address - Street 1:10273 ORTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-2505
Practice Address - Country:US
Practice Address - Phone:310-853-8025
Practice Address - Fax:310-853-8025
Is Sole Proprietor?:No
Enumeration Date:2012-05-01
Last Update Date:2015-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-12-10312103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst