Provider Demographics
NPI:1386672871
Name:FISHEL, LAWRENCE RAYMOND (PHD, LCSW-C)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:RAYMOND
Last Name:FISHEL
Suffix:
Gender:M
Credentials:PHD, LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 E PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21286-5118
Mailing Address - Country:US
Mailing Address - Phone:410-583-2222
Mailing Address - Fax:410-583-2377
Practice Address - Street 1:110 E PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-5118
Practice Address - Country:US
Practice Address - Phone:410-583-2222
Practice Address - Fax:410-583-2377
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD072051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD124221100Medicaid
MDKQ69 LQ22Medicare ID - Type Unspecified