Provider Demographics
NPI:1396263547
Name:FISHER, ALYSON DIROCCO (PSYD)
Entity type:Individual
Prefix:
First Name:ALYSON
Middle Name:DIROCCO
Last Name:FISHER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:ALYSON
Other - Middle Name:MARIE
Other - Last Name:DIROCCO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:11340 W OLYMPIC BLVD STE 268
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-1612
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11340 W OLYMPIC BLVD STE 268
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-1612
Practice Address - Country:US
Practice Address - Phone:310-668-4480
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2023-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY32858103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical