Provider Demographics
NPI:1568938702
Name:TEAL L. FITZPATRICK, PH.D., LLC
Entity Type:Organization
Organization Name:TEAL L. FITZPATRICK, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:TEAL
Authorized Official - Middle Name:L
Authorized Official - Last Name:FITZPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:412-532-9460
Mailing Address - Street 1:4037 HOWLEY ST
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15224-1438
Mailing Address - Country:US
Mailing Address - Phone:917-566-7500
Mailing Address - Fax:
Practice Address - Street 1:307 4TH AVE STE 1100
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15222-2107
Practice Address - Country:US
Practice Address - Phone:412-532-9460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2018-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1031000300001Medicaid