MEDICARE: MRS. JANINE ANNETTE FITCH LCSW-S

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	56838	TX

General Provider Information

NPI Number	:	1164620209
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JANINE ANNETTE FITCH LCSW-S

Provider Business Mailing Address
First Line	:	11522 FM 2015
Second Line	:
City	:	TYLER
State	:	TX
Zip	:	75708
Country	:	US
Telephone Number	:	785-577-1962
Fax Number	:	785-825-0062

Provider Business Practice Location Address
First Line	:	4500 S LANCASTER RD
Second Line	:	SOCIAL WORK SERVICES
City	:	DALLAS
State	:	TX
Zip	:	75216
Country	:	US
Telephone Number	:	737-420-4514
Fax Number	:	817-730-0559

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

Provider Enumeration Date	:	07/10/2007
Last Update Date	:	12/29/2025

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