Provider Demographics
NPI:1043451164
Name:FITZSIMMONS, SHAWN RACHELL
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:RACHELL
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1422 28TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-6423
Mailing Address - Country:US
Mailing Address - Phone:916-450-0700
Mailing Address - Fax:916-450-0703
Practice Address - Street 1:1422 28TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-6423
Practice Address - Country:US
Practice Address - Phone:916-450-0700
Practice Address - Fax:916-450-0703
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-19
Last Update Date:2009-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)