Provider Demographics
NPI:1831251404
Name:FISHBEIN, CAROL (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROL
Middle Name:
Last Name:FISHBEIN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 VILLAGE SQUARE XING
Mailing Address - Street 2:211
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-4540
Mailing Address - Country:US
Mailing Address - Phone:561-776-1944
Mailing Address - Fax:561-626-0594
Practice Address - Street 1:800 VILLAGE SQUARE XING
Practice Address - Street 2:211
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-4540
Practice Address - Country:US
Practice Address - Phone:561-776-1944
Practice Address - Fax:561-626-0594
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY0004551103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL59629Medicare ID - Type Unspecified