Healthcare Provider Details

I. General information

NPI: 1710254677
Provider Name (Legal Business Name): RALPH FITCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2011
Last Update Date: 11/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

945 FOREST ST
DOVER DE
19904-3401
US

IV. Provider business mailing address

945 FOREST ST
DOVER DE
19904-3401
US

V. Phone/Fax

Practice location:
  • Phone: 302-672-1500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number40195
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: