Provider Demographics
NPI:1730106667
Name:FITKIN, JUDITH L (CISW)
Entity type:Individual
Prefix:
First Name:JUDITH
Middle Name:L
Last Name:FITKIN
Suffix:
Gender:F
Credentials:CISW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5920 E PIMA ST
Mailing Address - Street 2:SUITE 140
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85712-4306
Mailing Address - Country:US
Mailing Address - Phone:520-733-2524
Mailing Address - Fax:520-733-3444
Practice Address - Street 1:5920 E PIMA ST
Practice Address - Street 2:SUITE 140
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85712-4306
Practice Address - Country:US
Practice Address - Phone:520-733-2524
Practice Address - Fax:520-733-3444
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW22741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS82054Medicare UPIN
AZ73256Medicare ID - Type Unspecified