Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | PSY 13676 | CA |
N | 103T00000X | Psychologist | PSY 13676 | CA |
Y | 103G00000X | Clinical Psychologist | PSY 13676 | CA |
Y | 103TC0700X | Clinical Psychologist | PSY 13676 | CA |
N | 103TC1900X | Counseling Psychologist | PSY 13676 | CA |
N | 103TF0000X | Family Psychologist | PSY 13676 | CA |
NPI | 1104851963 |
---|---|
Provider Name | Dr. Stephen M. Fitch |
First Address | Camarillo, CA 93010-3103 |
Second Address | Camarillo, CA 93010-3103 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/07/2006 |
Last Update Date | 20/08/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
OPL136760 | BLUE SHIELD OF CALIFORNIA (01) | CA |
PSY 136760 | (05) | CA |