Healthcare Provider Details

I. General information

NPI: 1649132168
Provider Name (Legal Business Name): REGINA EVE FITZPATRICK MS, EDD, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2025
Last Update Date: 12/02/2025
Certification Date: 12/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28 MINEAH RD
FREEVILLE NY
13068-9522
US

IV. Provider business mailing address

609 STEVENSON ST
SAYRE PA
18840-1411
US

V. Phone/Fax

Practice location:
  • Phone: 607-425-2848
  • Fax:
Mailing address:
  • Phone: 607-425-2848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number018-P139783
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: