Provider Demographics
NPI:1558083675
Name:FITZPATRICK, ELIZABETH MALDONADO (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:MALDONADO
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 1:19735 CAMINO ARROYO
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-1712
Mailing Address - Country:US
Mailing Address - Phone:818-219-1715
Mailing Address - Fax:
Practice Address - Street 1:19735 CAMINO ARROYO
Practice Address - Street 2:
Practice Address - City:WALNUT
Practice Address - State:CA
Practice Address - Zip Code:91789-1712
Practice Address - Country:US
Practice Address - Phone:818-219-1715
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-15
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW188831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical