MEDICARE: DR. JENNIFER SUSANNA FITCH PSYD

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	103T00000X	Psychologist	PSY20317	CA

General Provider Information

NPI Number	:	1679777015
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER SUSANNA FITCH PSYD

Provider Business Mailing Address
First Line	:	424 JESSIE ST STE 7
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1848
Country	:	US
Telephone Number	:	415-543-5277
Fax Number	:	415-348-4693

Provider Business Practice Location Address
First Line	:	424 JESSIE ST STE 7
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94103-1848
Country	:	US
Telephone Number	:	415-543-5277
Fax Number	:	415-348-4693

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

Provider Enumeration Date	:	06/11/2007
Last Update Date	:	07/08/2007

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