Provider Demographics
NPI:1316143076
Name:FISHER, DAVID BERNARD (MSW)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:BERNARD
Last Name:FISHER
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23965 NOVI RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48375-3231
Mailing Address - Country:US
Mailing Address - Phone:248-344-7420
Mailing Address - Fax:248-344-7423
Practice Address - Street 1:23965 NOVI RD
Practice Address - Street 2:SUITE 110
Practice Address - City:NOVI
Practice Address - State:MI
Practice Address - Zip Code:48375-3231
Practice Address - Country:US
Practice Address - Phone:248-344-7420
Practice Address - Fax:248-344-7423
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6801060429104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI512497OtherVALUE OPTIONS
MI8008968690OtherBC PIN