Basic Information
Provider Information
NPI: 1710975537
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: FISHELMAN
FirstName: LESLEY
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 280 CHESTNUT STREET
Address2: 2ND FLOOR
City: SPRINGFIELD
State: MA
PostalCode: 011991619
CountryCode: US
TelephoneNumber: 4137945700
FaxNumber:  
Practice Location
Address1: 42 WRIGHT STREET
Address2:  
City: PALMER
State: MA
PostalCode: 010691156
CountryCode: US
TelephoneNumber: 4132845285
FaxNumber: 4132845384
Other Information
ProviderEnumerationDate: 10/06/2005
LastUpdateDate: 02/17/2016
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2084P0800X46243MAY Allopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry

No ID Information.


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