Provider Demographics
NPI:1457463846
Name:FISHBEIN, SUSAN H (PSYD)
Entity type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:H
Last Name:FISHBEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 DUNKIRK RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21212-2015
Mailing Address - Country:US
Mailing Address - Phone:410-521-2150
Mailing Address - Fax:410-377-2162
Practice Address - Street 1:604 DUNKIRK RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-2015
Practice Address - Country:US
Practice Address - Phone:410-521-2150
Practice Address - Fax:410-377-2162
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01936103TA0700X, 103TC0700X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Not Answered103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD227837OtherCOMPSYCH
MDT6080002OtherFEDERALBCAND BLUECHOICE
MD350959-01OtherMARYLAND BLUECROSSBLUESHI
MDPVPB6480OtherAPS
MD227837OtherCOMPSYCH
MDT6080002OtherFEDERALBCAND BLUECHOICE