Provider Demographics
NPI:1649651118
Name:FRITSCH, STEPHEN PAUL (PSYD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:PAUL
Last Name:FRITSCH
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:DR
Other - First Name:STEPHEN
Other - Middle Name:P
Other - Last Name:FRITSCH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:375 DIXMYTH AVE
Mailing Address - Street 2:DEPARTMENT OF BEHAVIORAL HEALTH (10 J)
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45220-2475
Mailing Address - Country:US
Mailing Address - Phone:513-862-2823
Mailing Address - Fax:
Practice Address - Street 1:375 DIXMYTH AVE
Practice Address - Street 2:DEPARTMENT OF BEHAVIORAL HEALTH (10 J)
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45220-2475
Practice Address - Country:US
Practice Address - Phone:513-862-2823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2015-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3925103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHR88449Medicare UPIN