Provider Demographics
NPI:1720412711
Name:PETER FOSTER-FISHMAN, PSY.D.
Entity type:Organization
Organization Name:PETER FOSTER-FISHMAN, PSY.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:FOSTER-FISHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:517-337-2715
Mailing Address - Street 1:1046 CRESENWOOD RD
Mailing Address - Street 2:
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823-4120
Mailing Address - Country:US
Mailing Address - Phone:517-337-2715
Mailing Address - Fax:
Practice Address - Street 1:1046 CRESENWOOD RD
Practice Address - Street 2:
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823-4120
Practice Address - Country:US
Practice Address - Phone:517-337-2715
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-26
Last Update Date:2013-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health