MEDICARE: MELISSA FITZSIMMONS ASW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	80244	CA

General Provider Information

NPI Number	:	1174001473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MELISSA FITZSIMMONS ASW

Provider Business Mailing Address
First Line	:	PO BOX 8282
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90808-0282
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	17330 NEWHOPE ST STE A
Second Line	:
City	:	FOUNTAIN VALLEY
State	:	CA
Zip	:	92708-4225
Country	:	US
Telephone Number	:	844-349-0077
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/30/2018
Last Update Date	:	07/30/2018

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