MEDICARE: KATHLEEN FITZPATRICK, LMHC LLC

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	MH8556	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1447459383	OTHER	FL	INDIVIDUAL NPI

General Provider Information

NPI Number	:	1821353434
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KATHLEEN FITZPATRICK, LMHC LLC

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	:	407-492-1713
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	KATHLEEN FITZPATRICK
Credential	:
Telephone Number	:	407-492-1713

Provider Enumeration Date	:	07/10/2012
Last Update Date	:	07/10/2012

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