MEDICARE: DR. MOIRA FITZPATRICK PHD

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	175F00000X	Naturopath	NT60010575	WA
2	103TC0700X	Clinical Psychologist	PY00002712	WA
3	103TC0700X	Clinical Psychologist	PSY11413	CA

General Provider Information

NPI Number	:	1598858813
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MOIRA FITZPATRICK PHD

Provider Business Mailing Address
First Line	:	3609 SACRAMENTO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1709
Country	:	US
Telephone Number	:	415-237-0377
Fax Number	:

Provider Business Practice Location Address
First Line	:	3609 SACRAMENTO ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94118-1709
Country	:	US
Telephone Number	:	415-237-0377
Fax Number	:

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

Provider Enumeration Date	:	09/30/2006
Last Update Date	:	02/28/2024

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