Provider Demographics
NPI:1184961096
Name:FITCH, KRISTIN D (PSYD)
Entity type:Individual
Prefix:DR
First Name:KRISTIN
Middle Name:D
Last Name:FITCH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 ALTA VISTA CT
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-4609
Mailing Address - Country:US
Mailing Address - Phone:925-309-2980
Mailing Address - Fax:
Practice Address - Street 1:675 HARTZ AVE
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-3838
Practice Address - Country:US
Practice Address - Phone:925-309-2980
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical