Provider Demographics
NPI:1336362045
Name:FISHMAN, K. HEIDI (EDD)
Entity Type:Individual
Prefix:DR
First Name:K.
Middle Name:HEIDI
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:367 STATE ROUTE 120
Mailing Address - Street 2:SUITE B8
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1430
Mailing Address - Country:US
Mailing Address - Phone:603-643-6663
Mailing Address - Fax:603-643-9020
Practice Address - Street 1:367 STATE ROUTE 120
Practice Address - Street 2:SUITE B8
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1430
Practice Address - Country:US
Practice Address - Phone:603-643-6663
Practice Address - Fax:603-643-9020
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH681103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist