Provider Demographics
NPI:1437226727
Name:FITZPATRICK, MARY C (LCSW)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:C
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 1:853 BROADWAY 701
Mailing Address - Street 2:SUITE 701
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10003
Mailing Address - Country:US
Mailing Address - Phone:212-529-0960
Mailing Address - Fax:212-529-4145
Practice Address - Street 1:853 BROADWAY
Practice Address - Street 2:SUITE 701
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10003
Practice Address - Country:US
Practice Address - Phone:212-529-0960
Practice Address - Fax:212-529-4145
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0178901041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
0068813OtherGHI
164314OtherMHN