Provider Demographics
NPI:1740755826
Name:FISHER, ANTOINETTE JANIE-IDA (MS, BCBA, COBA)
Entity type:Individual
Prefix:
First Name:ANTOINETTE
Middle Name:JANIE-IDA
Last Name:FISHER
Suffix:
Gender:F
Credentials:MS, BCBA, COBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4668 ERHART DR
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-4443
Mailing Address - Country:US
Mailing Address - Phone:216-396-9805
Mailing Address - Fax:
Practice Address - Street 1:4668 ERHART DR
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-4443
Practice Address - Country:US
Practice Address - Phone:216-376-9805
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-04
Last Update Date:2024-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251S00000X
OH1-24-76489103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No251S00000XAgenciesCommunity/Behavioral Health