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General NPI Number Information
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NPI Number | 1457696932
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Entity Type | Individual
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Provider Name | MARY FITZPATRICK
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Gender | Female
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Dates
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Enumeration Date | 12/10/2012
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Last Update Date | 04/26/2018
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Provider Practice Location Address
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Address Line | 444 CENTER ST
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City | MANCHESTER
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State | CT
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Zip | 06040-3926
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Country | US
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Telephone | 860-243-6584
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Fax | 860-243-6591
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Provider Business Mailing Address
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Address Line | 995 DAY HILL RD
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City | WINDSOR
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State | CT
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Zip | 06095-1722
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Country | US
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Telephone | 860-731-5522
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Fax | 860-731-5536
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 003425
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License Number State | CT
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