Provider Demographics
NPI:1578515912
Name:FITZSIMMONS, DANIEL FRANCIS (PSYD)
Entity Type:Individual
Prefix:MR
First Name:DANIEL
Middle Name:FRANCIS
Last Name:FITZSIMMONS
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3665 75TH ST N
Mailing Address - Street 2:
Mailing Address - City:SAINT PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33710-1255
Mailing Address - Country:US
Mailing Address - Phone:727-341-0517
Mailing Address - Fax:
Practice Address - Street 1:4464 CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33711-1142
Practice Address - Country:US
Practice Address - Phone:727-422-6945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6364103TC0700X
FLAP1917171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE6723Medicare UPIN