MEDICARE: DR. STEPHANIE A FITZWILLIAM

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	103TC0700X	Clinical Psychologist	2975	PR

General Provider Information

NPI Number	:	1952572810
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHANIE A FITZWILLIAM

Provider Business Mailing Address
First Line	:	M31 CALLE 13
Second Line	:	CONDADO MODERNO
City	:	CAGUAS
State	:	PR
Zip	:	00725-2443
Country	:	US
Telephone Number	:	787-703-4050
Fax Number	:	787-703-4115

Provider Business Practice Location Address
First Line	:	COND. EL BOSQUE
Second Line	:	APT.1203
City	:	GUAYNABO
State	:	PR
Zip	:	00971
Country	:	US
Telephone Number	:	787-593-8380
Fax Number	:	787-720-9464

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

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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