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NPI Code Detail

MEDICARE: MR. SCOTT FITZGERALD PATRICK CDCA II

MEDICARE: MR. SCOTT FITZGERALD PATRICK CDCA II
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
1101YA0400XAddiction (Substance Use Disorder) Counselor163624OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1518464031
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SCOTT FITZGERALD PATRICK CDCA II
Provider Business Mailing Address
First Line : 18 S. PAINT ST.
Second Line :
City : CHILLICOTHEE
State : OH
Zip : 45601
Country : US
Telephone Number : 740-771-9051
Fax Number :
Provider Business Practice Location Address
First Line : 111 W WATER ST
Second Line :
City : CHILLICOTHEE
State : OH
Zip : 45601-2452
Country : US
Telephone Number : 740-851-4432
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/11/2018
Last Update Date : 06/22/2021

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