Provider Demographics
NPI:1952572810
Name:FITZWILLIAM, STEPHANIE A
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:A
Last Name:FITZWILLIAM
Suffix:
Gender:F
Credentials:
Other - Prefix:DR
Other - First Name:STEPHANIE
Other - Middle Name:A
Other - Last Name:FITZWILLIAM
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:M31 CALLE 13
Mailing Address - Street 2:CONDADO MODERNO
Mailing Address - City:CAGUAS
Mailing Address - State:PR
Mailing Address - Zip Code:00725-2443
Mailing Address - Country:US
Mailing Address - Phone:787-703-4050
Mailing Address - Fax:787-703-4115
Practice Address - Street 1:COND. EL BOSQUE
Practice Address - Street 2:APT.1203
Practice Address - City:GUAYNABO
Practice Address - State:PR
Practice Address - Zip Code:00971
Practice Address - Country:US
Practice Address - Phone:787-593-8380
Practice Address - Fax:787-720-9464
Is Sole Proprietor?:No
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR2975103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical