Healthcare Provider Details

I. General information

NPI: 1104851963
Provider Name (Legal Business Name): STEPHEN M. FITCH PHD.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 08/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1601 CARMEN DRIVE SUITE #111
CAMARILLO CA
93010-3103
US

IV. Provider business mailing address

1601 CARMEN DRIVE SUITE #111
CAMARILLO CA
93010-3103
US

V. Phone/Fax

Practice location:
  • Phone: 805-987-7006
  • Fax:
Mailing address:
  • Phone: 805-987-7006
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY 13676
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License NumberPSY 13676
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License NumberPSY 13676
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY 13676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: