Provider Demographics
NPI:1417314949
Name:FITZPATRICK, MARIA I (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:I
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118-2600
Mailing Address - Country:US
Mailing Address - Phone:617-534-3134
Mailing Address - Fax:617-534-3134
Practice Address - Street 1:201 RIVER ST
Practice Address - Street 2:
Practice Address - City:MATTAPAN
Practice Address - State:MA
Practice Address - Zip Code:02126-2713
Practice Address - Country:US
Practice Address - Phone:617-534-2524
Practice Address - Fax:617-419-1474
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-28
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1207971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical