Provider Demographics
NPI:1598807463
Name:FITZPATRICK, MARIA (MA OTRL)
Entity Type:Individual
Prefix:MRS
First Name:MARIA
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MA OTRL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:389 RICHMOND BLVD
Mailing Address - Street 2:
Mailing Address - City:RONKONKOMA
Mailing Address - State:NY
Mailing Address - Zip Code:11779-3851
Mailing Address - Country:US
Mailing Address - Phone:631-467-1891
Mailing Address - Fax:
Practice Address - Street 1:389 RICHMOND BLVD
Practice Address - Street 2:
Practice Address - City:RONKONKOMA
Practice Address - State:NY
Practice Address - Zip Code:11779-3851
Practice Address - Country:US
Practice Address - Phone:631-467-1891
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007149-1174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist