Individual provider Active NPI

Mary Alice Fisher, PH.D.

  • Clinical Psychologist
  • Charlottesville, VA
National Provider Identifier
1700953775
Registry record updated Dec 14, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
0810-001185 Issued in VA
Practice address
934 E Jefferson St
Charlottesville, VA 22902-5326
Phone
(434) 971-1841
Fax
(434) 971-6924
NPI assigned
Nov 29, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 14, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 0810-001185 VA Primary

Addresses

Primary practice location

934 E Jefferson St
Charlottesville, VA 22902-5326

Mailing address

934 E Jefferson St
Charlottesville, VA 22902-5326
Phone (434) 971-1841

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0810-001185VAMDClinical Psychologist

NPI Registry JSON

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

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1418515200000",
    "number": "1700953775",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "934 E JEFFERSON ST",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229025326",
            "telephone_number": "434-971-1841",
            "fax_number": "434-971-6924"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "934 E JEFFERSON ST",
            "city": "CHARLOTTESVILLE",
            "state": "VA",
            "postal_code": "229025326",
            "telephone_number": "434-971-1841",
            "fax_number": "434-971-6924"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FISHER",
        "first_name": "MARY",
        "middle_name": "ALICE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-11-29",
        "last_updated": "2014-12-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810-001185",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Charlottesville, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 14, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.