Provider Demographics
NPI:1508901877
Name:FITZMARTIN, STEPHEN J (MSW)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:J
Last Name:FITZMARTIN
Suffix:
Gender:M
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1815 JOHN F KENNEDY BLVD APT 2804
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19103-1724
Mailing Address - Country:US
Mailing Address - Phone:215-563-0699
Mailing Address - Fax:
Practice Address - Street 1:1815 JOHN F KENNEDY BLVD APT 2804
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-1724
Practice Address - Country:US
Practice Address - Phone:215-287-6463
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2012-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA095452K53Medicare ID - Type UnspecifiedMEDICARE NUMBER