Healthcare Provider Details

I. General information

NPI: 1558083675
Provider Name (Legal Business Name): ELIZABETH MALDONADO FITZPATRICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2022
Last Update Date: 09/15/2022
Certification Date: 09/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19735 CAMINO ARROYO
WALNUT CA
91789-1712
US

IV. Provider business mailing address

19735 CAMINO ARROYO
WALNUT CA
91789-1712
US

V. Phone/Fax

Practice location:
  • Phone: 818-219-1715
  • Fax:
Mailing address:
  • Phone: 818-219-1715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCSW18883
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: