MEDICARE: STEPHEN J FITZMARTIN MSW

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	104100000X	Social Worker

General Provider Information

NPI Number	:	1508901877
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHEN J FITZMARTIN MSW

Provider Business Mailing Address
First Line	:	1815 JOHN F KENNEDY BLVD APT 2804
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1724
Country	:	US
Telephone Number	:	215-563-0699
Fax Number	:

Provider Business Practice Location Address
First Line	:	1815 JOHN F KENNEDY BLVD APT 2804
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19103-1724
Country	:	US
Telephone Number	:	215-287-6463
Fax Number	:

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

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	06/11/2012

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