Provider Demographics
NPI:1386135119
Name:FISHER-KLEIN, TOMMY S
Entity type:Individual
Prefix:
First Name:TOMMY
Middle Name:S
Last Name:FISHER-KLEIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1348 BAINBRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19147-1810
Mailing Address - Country:US
Mailing Address - Phone:215-563-0652
Mailing Address - Fax:
Practice Address - Street 1:500 W 40TH ST
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19802-2128
Practice Address - Country:US
Practice Address - Phone:302-256-1062
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-29
Last Update Date:2018-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health