MEDICARE: BLYTHE A FITZHARRIS PH.D., LCSW

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	LCSW-10542	AZ

General Provider Information

NPI Number	:	1912342924
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BLYTHE A FITZHARRIS PH.D., LCSW

Provider Business Mailing Address
First Line	:	1351 N PLEASANT DR UNIT 2107
Second Line	:
City	:	CHANDLER
State	:	AZ
Zip	:	85225-7933
Country	:	US
Telephone Number	:	602-920-0486
Fax Number	:

Provider Business Practice Location Address
First Line	:	2255 W NORTHERN AVE
Second Line	:	SUITE B100
City	:	PHOENIX
State	:	AZ
Zip	:	85021-4936
Country	:	US
Telephone Number	:	602-995-1767
Fax Number	:

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

Provider Enumeration Date	:	05/03/2013
Last Update Date	:	05/03/2013

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