Basic Information
| Provider Information | |||||||||
| NPI: | 1942449772 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FISHMAN | ||||||||
| FirstName: | DEBRA | ||||||||
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| Credential: | PSY.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3630 BUSINESS DR | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958202163 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167344291 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3301 C ST STE 1500 | ||||||||
| Address2: | |||||||||
| City: | SACRAMENTO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 958163371 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9167347463 | ||||||||
| FaxNumber: | 9167341500 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2009 | ||||||||
| LastUpdateDate: | 12/19/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0004X | PSY22462 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Health | 103TC0700X | PSY22462 | CA | N | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.