Doctor Name: | BRUCE FISCHER |
NPI Number: | 1366430746 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | 1049 |
Business Practice Address: | 1026 Snowberry Dr Longs, SC - 295688120 |
Business Phone Number: | 6319461249 |
Business Fax Number: | |
Mailing Address: | 1026 Snowberry Dr, LONGS |
State: | SC |
Postal Code: | 295688120 |
Phone Number: | 6319461249 |
Fax Number: | |
NPI Enumeration Date: | 10/11/2005 |
NPI Last Update Date: | 12/31/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 1049 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | SC |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |