Healthcare Provider Details

I. General information

NPI: 1457286635
Provider Name (Legal Business Name): SEQUOYA FITZPATRICK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 CENTERVILLE RD STE 301
WARWICK RI
02886-4376
US

IV. Provider business mailing address

535 CENTERVILLE RD STE 301
WARWICK RI
02886-4376
US

V. Phone/Fax

Practice location:
  • Phone: 401-206-0304
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPS02458
License Number StateRI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: