Provider Demographics
NPI:1558530360
Name:FITZPATRICK, JOHN C (PH D, CASAC)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:C
Last Name:FITZPATRICK
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Gender:M
Credentials:PH D, CASAC
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Mailing Address - Street 1:5800 3RD AVE
Mailing Address - Street 2:LUTHERAN MEDICAL CENTER MANAGED CARE DEPARMENT
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11220-3702
Mailing Address - Country:US
Mailing Address - Phone:718-630-7477
Mailing Address - Fax:718-630-7437
Practice Address - Street 1:514 49TH ST
Practice Address - Street 2:LMC-SUNSET TERRACE FAMILY HEALTH CENTER
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11220-2010
Practice Address - Country:US
Practice Address - Phone:718-854-1851
Practice Address - Fax:718-437-5239
Is Sole Proprietor?:No
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
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Provider Licenses
StateLicense IDTaxonomies
NYCASAC-972101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)