Provider Demographics
NPI:1598917239
Name:FITCH, BERNADETTE (LAC)
Entity Type:Individual
Prefix:
First Name:BERNADETTE
Middle Name:
Last Name:FITCH
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 FABRIZIO DR
Mailing Address - Street 2:
Mailing Address - City:NEWBURGH
Mailing Address - State:NY
Mailing Address - Zip Code:12550-1048
Mailing Address - Country:US
Mailing Address - Phone:914-213-1967
Mailing Address - Fax:
Practice Address - Street 1:1181 NORTH AVE
Practice Address - Street 2:
Practice Address - City:BEACON
Practice Address - State:NY
Practice Address - Zip Code:12508-1700
Practice Address - Country:US
Practice Address - Phone:914-213-1967
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-14
Last Update Date:2008-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY003085171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist