Martin Brian Fisher Jr., PSYD

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

2383 Issued in OR

Practice address

1215 SW 18TH Ave
Suite 4
Portland, OR 97205-1711

Phone

(503) 318-3236

NPI assigned

Aug 6, 2013

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Previously, effective Aug 12, 2024 through Aug 12, 2026

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1375747200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1404345600000",
    "number": "1245662741",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2420 SE TAYLOR ST",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972142858",
            "telephone_number": "503-318-3236"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1215 SW 18TH AVE",
            "address_2": "SUITE 4",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972051711",
            "telephone_number": "503-318-3236"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "MARTIN",
        "middle_name": "BRIAN",
        "name_suffix": "Jr.",
        "credential": "PSYD",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2013-08-06",
        "last_updated": "2014-07-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "OR",
            "license": "2383",
            "primary": true
        },
        {
            "code": "103TA0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Adult Development & Aging",
            "state": "OR",
            "license": "2383",
            "primary": false
        },
        {
            "code": "103TC2200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical Child & Adolescent",
            "state": "OR",
            "license": "2383",
            "primary": false
        },
        {
            "code": "103TF0000X",
            "taxonomy_group": "",
            "desc": "Psychologist, Family",
            "state": "OR",
            "license": "2383",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kimbery Paige Fisher
• Lauren Winslow Fisher, MD
• Leslie Fisher
• Lora Maureen Fisher, DO
• Maquel Fisher, LMT
• Mary Elizabeth Fisher, PHD, LMFT
• Meghan Fisher
• Michelle Carmen Fisher
• Michelle Marie Fisher, MA, CADC APPLICANT
• Pamela Ann Fisher, M.D.

• Clinical Psychologist in Portland, OR
• Providers in Portland, OR by specialty
• Clinical Psychologist in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 3, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.