Brenda Fisher
Individual provider Active NPI Psychologist · Glen Head, NY
NPI 1154979656 · NPPES record last updated Aug 28, 2019
Key facts
- NPI
- 1154979656
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 013088-1 (NY)
- Practice address
- 240 Glen Cove Rd
Glen Head, NY 11545-2207 - Phone
- (516) 659-4891
- NPI assigned
- Aug 28, 2019
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 013088-1 | NY | MD | Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 013088-1 | NY | Yes |
Addresses
Primary practice location
240 Glen Cove Rd
Glen Head, NY 11545-2207
Mailing address
3000 Royal CT Unit 3104
North Hills, NY 11040-2633
Phone (516) 692-5203
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 013088-1 | Other | NY | LICENSE NUMBER |
Other providers in Glen Head, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 28, 2019. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.