Provider Demographics
NPI:1376754325
Name:FITZHUGH, RICHARD D (LCSW)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:D
Last Name:FITZHUGH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 HIGH POINT DR PH 11
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-4416
Mailing Address - Country:US
Mailing Address - Phone:014-048-6588
Mailing Address - Fax:914-948-6588
Practice Address - Street 1:221 E HARTSDALE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:HARTSDALE
Practice Address - State:NY
Practice Address - Zip Code:10530-3572
Practice Address - Country:US
Practice Address - Phone:914-725-4165
Practice Address - Fax:914-725-6675
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047274-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYPRO N4MMedicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER