Provider Demographics
NPI:1568600559
Name:FITZPATRICK, JOANN (MA)
Entity Type:Individual
Prefix:MRS
First Name:JOANN
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4229 KNOXVILLE AVE
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-3223
Mailing Address - Country:US
Mailing Address - Phone:310-938-4555
Mailing Address - Fax:
Practice Address - Street 1:3424 W CARSON ST
Practice Address - Street 2:SUITE #580
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90503-5701
Practice Address - Country:US
Practice Address - Phone:310-938-4555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 36943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist