Provider Demographics
NPI:1316035553
Name:FITZSIMMONS, MARION (PHD, NP)
Entity Type:Individual
Prefix:DR
First Name:MARION
Middle Name:
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:PHD, NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2075 SCOTTSVILLE RD.
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14609
Mailing Address - Country:US
Mailing Address - Phone:585-429-2740
Mailing Address - Fax:585-429-2800
Practice Address - Street 1:2075 SCOTTSVILLE RD.
Practice Address - Street 2:CRESTWOOD CHILDREN'S CENTER
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14609
Practice Address - Country:US
Practice Address - Phone:585-429-2740
Practice Address - Fax:585-429-2800
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-11
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010873103TC0700X
NYF400121363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health