Provider Demographics
NPI:1427261700
Name:FISHER, ROBERT LAWRENCE (PHD)
Entity type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:LAWRENCE
Last Name:FISHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:169 MARINA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-2141
Mailing Address - Country:US
Mailing Address - Phone:510-853-2405
Mailing Address - Fax:
Practice Address - Street 1:169 MARINA VISTA AVE
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-2141
Practice Address - Country:US
Practice Address - Phone:510-853-2405
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5434103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical