Basic Information
| Provider Information | |||||||||
| NPI: | 1588741730 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FISHER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | STEVEN | ||||||||
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| Credential: | PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 286 5TH AVE | ||||||||
| Address2: | 10F | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100014512 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6469350701 | ||||||||
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| Practice Location | |||||||||
| Address1: | 910 W END AVE | ||||||||
| Address2: | #1C | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100253533 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2128518100 | ||||||||
| FaxNumber: | 2129320964 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/01/2006 | ||||||||
| LastUpdateDate: | 02/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 013619 | NY | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical | 103TA0400X | 013619 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Addiction (Substance Use Disorder) | 103TP2701X | 013619 | NY | N | Behavioral Health & Social Service Providers | Psychologist | Group Psychotherapy |
No ID Information.