Healthcare Provider Details

I. General information

NPI: 1033604814
Provider Name (Legal Business Name): JOSEPH RICHARD FITZPATRICK PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

88 CUMBERLAND RD
NORTH YARMOUTH ME
04097-6544
US

IV. Provider business mailing address

88 CUMBERLAND RD
NORTH YARMOUTH ME
04097-6544
US

V. Phone/Fax

Practice location:
  • Phone: 207-310-1575
  • Fax:
Mailing address:
  • Phone: 207-310-1575
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: