Provider Demographics
NPI:1740962737
Name:FISCHER, MOLLY ALEEN (BCBA)
Entity type:Individual
Prefix:MS
First Name:MOLLY
Middle Name:ALEEN
Last Name:FISCHER
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 1:1001 TIVERTON AVE APT 2164
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90024-3041
Mailing Address - Country:US
Mailing Address - Phone:719-331-1017
Mailing Address - Fax:
Practice Address - Street 1:5435 BALBOA BLVD STE 202
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1570
Practice Address - Country:US
Practice Address - Phone:706-968-6963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-21-55845103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst