Provider Demographics
NPI:1598858813
Name:FITZPATRICK, MOIRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:MOIRA
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3609 SACRAMENTO ST
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1709
Mailing Address - Country:US
Mailing Address - Phone:415-237-0377
Mailing Address - Fax:
Practice Address - Street 1:3609 SACRAMENTO ST
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1709
Practice Address - Country:US
Practice Address - Phone:415-237-0377
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-30
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WANT60010575175F00000X
WAPY00002712103TC0700X
CAPSY11413103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8862899Medicare UPIN