Provider Demographics
NPI:1023153988
Name:FISHMAN, DOROTHY CARRIE (PHD)
Entity type:Individual
Prefix:DR
First Name:DOROTHY
Middle Name:CARRIE
Last Name:FISHMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:MS
Other - First Name:DOROTHY
Other - Middle Name:FISHMAN
Other - Last Name:PORTNOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:400 FORGE ROAD
Mailing Address - Street 2:
Mailing Address - City:NORTH KINGSTOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02852-1052
Mailing Address - Country:US
Mailing Address - Phone:401-884-5122
Mailing Address - Fax:401-884-1612
Practice Address - Street 1:400 FORGE ROAD
Practice Address - Street 2:
Practice Address - City:NORTH KINGSTOWN
Practice Address - State:RI
Practice Address - Zip Code:02852-1052
Practice Address - Country:US
Practice Address - Phone:401-884-5122
Practice Address - Fax:401-884-1612
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIPS343103TC0700X
MA4266103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical