Healthcare Provider Details

I. General information

NPI: 1598870545
Provider Name (Legal Business Name): PATRICIA M FITZPATRICK LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2006
Last Update Date: 11/10/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 LOWER LAKESHORE DR
KATONAH NY
10536-2644
US

IV. Provider business mailing address

8 LOWER LAKESHORE DR
KATONAH NY
10536-2644
US

V. Phone/Fax

Practice location:
  • Phone: 914-523-1473
  • Fax:
Mailing address:
  • Phone: 914-523-1473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberR038425-1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: