Provider Demographics
NPI:1609084433
Name:FITZPATRICK, PHYLLIS B (MSW)
Entity Type:Individual
Prefix:MS
First Name:PHYLLIS
Middle Name:B
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 ANGELICA DR
Mailing Address - Street 2:
Mailing Address - City:FRAMINGHAM
Mailing Address - State:MA
Mailing Address - Zip Code:01701-3644
Mailing Address - Country:US
Mailing Address - Phone:508-277-8768
Mailing Address - Fax:
Practice Address - Street 1:317 N MAIN ST
Practice Address - Street 2:
Practice Address - City:NATICK
Practice Address - State:MA
Practice Address - Zip Code:01760-1115
Practice Address - Country:US
Practice Address - Phone:508-277-8768
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA485225700000X
MA10202351041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPO5966Medicare PIN