Provider Demographics
NPI:1295041366
Name:FITZPATRICK, TEAL LOUISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:TEAL
Middle Name:LOUISE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4037 HOWLEY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1438
Mailing Address - Country:US
Mailing Address - Phone:412-532-9460
Mailing Address - Fax:
Practice Address - Street 1:307 4TH AVE
Practice Address - Street 2:SUITE 1100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2108
Practice Address - Country:US
Practice Address - Phone:412-532-9460
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-26
Last Update Date:2017-04-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017991103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA473615Medicare PIN