Provider Demographics
NPI:1407901036
Name:FITZPATRICK, CHRISTINE FERRERI (MACCC-SLP)
Entity Type:Individual
Prefix:MS
First Name:CHRISTINE
Middle Name:FERRERI
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MACCC-SLP
Other - Prefix:
Other - First Name:CHRISTINE
Other - Middle Name:
Other - Last Name:FERRERI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1115 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:WEST ISLIP
Mailing Address - State:NY
Mailing Address - Zip Code:11795-1621
Mailing Address - Country:US
Mailing Address - Phone:516-658-6979
Mailing Address - Fax:
Practice Address - Street 1:6253 CATALINA DR UNIT 1131
Practice Address - Street 2:
Practice Address - City:NORTH MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29582-9580
Practice Address - Country:US
Practice Address - Phone:516-658-6979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2014-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY006922-1235Z00000X
GASLP008567235Z00000X
SC5508235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist