Provider Demographics
NPI:1306380811
Name:FITCH, KRISTIN EVELYN (PHD)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:EVELYN
Last Name:FITCH
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 CANAL ST # 103
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70119-6109
Mailing Address - Country:US
Mailing Address - Phone:504-977-2229
Mailing Address - Fax:504-226-0479
Practice Address - Street 1:3500 CANAL ST # 103
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70119-6109
Practice Address - Country:US
Practice Address - Phone:504-977-2229
Practice Address - Fax:504-226-0479
Is Sole Proprietor?:No
Enumeration Date:2016-12-19
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1393103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical