Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 2912 | MA |
N | 103TC0700X | Clinical Psychologist | 2912 | MA |
N | 103TC2200X | Clinical Child & Adolescent Psychologist | 2912 | MA |
N | 103TF0000X | Family Psychologist | 2912 | MA |
N | 103TH0100X | Health Service | 2912 | MA |
NPI | 1285799965 |
---|---|
Provider Name | Stuart G Fisher |
First Address | Worcester, MA 01609-1404 |
Second Address | Worcester, MA 01609-1404 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/12/2006 |
Last Update Date | 08/07/2007 |