MEDICARE: KATHLEEN FITZPATRICK LMHC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	MH 8556	FL

General Provider Information

NPI Number	:	1447459383
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATHLEEN FITZPATRICK LMHC

Provider Business Mailing Address
First Line	:	PO BOX 783662
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34778-3662
Country	:	US
Telephone Number	:	407-492-1713
Fax Number	:

Provider Business Practice Location Address
First Line	:	6220 S ORANGE BLOSSOM TRL
Second Line	:	SUITE #188
City	:	ORLANDO
State	:	FL
Zip	:	32809-4630
Country	:	US
Telephone Number	:	407-571-7638
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/11/2007
Last Update Date	:	07/11/2007

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