MEDICARE: DR. STEPHEN M. FITCH PHD.

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	PSY 13676	CA
2	103TC1900X	Counseling Psychologist	PSY 13676	CA
3	103TF0000X	Family Psychologist	PSY 13676	CA
4	103T00000X	Psychologist	PSY 13676	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	OPL136760	OTHER	CA	BLUE SHIELD OF CALIFORNIA

General Provider Information

NPI Number	:	1104851963
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STEPHEN M. FITCH PHD.

Provider Business Mailing Address
First Line	:	1601 CARMEN DRIVE
Second Line	:	SUITE #111
City	:	CAMARILLO
State	:	CA
Zip	:	93010-3103
Country	:	US
Telephone Number	:	805-987-7006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1601 CARMEN DRIVE
Second Line	:	SUITE #111
City	:	CAMARILLO
State	:	CA
Zip	:	93010-3103
Country	:	US
Telephone Number	:	805-987-7006
Fax Number	:

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

Provider Enumeration Date	:	07/11/2006
Last Update Date	:	08/20/2010

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Directions to “ DR. STEPHEN M. FITCH PHD.” Practice Location

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