Provider Demographics
NPI:1215504956
Name:FISHER, JANINE
Entity type:Individual
Prefix:MR
First Name:JANINE
Middle Name:
Last Name:FISHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:DANIEL
Other - Middle Name:
Other - Last Name:FISHER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:316 N HARVARD ST UNIT 3
Mailing Address - Street 2:
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-1531
Mailing Address - Country:US
Mailing Address - Phone:832-454-9123
Mailing Address - Fax:
Practice Address - Street 1:399 LINCOLN RD # 1218
Practice Address - Street 2:
Practice Address - City:WALPOLE
Practice Address - State:MA
Practice Address - Zip Code:02081-1218
Practice Address - Country:US
Practice Address - Phone:508-668-7703
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-10
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensic