Provider Demographics
NPI:1457436446
Name:FISHER, WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:888 EASTON AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1898
Mailing Address - Country:US
Mailing Address - Phone:848-800-8502
Mailing Address - Fax:
Practice Address - Street 1:888 EASTON AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1898
Practice Address - Country:US
Practice Address - Phone:848-800-8502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00626400103TB0200X
NE633103TB0200X
NJ1-08-4742103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE10028257200Medicaid
NE10028257200Medicaid