Provider Demographics
NPI:1609240431
Name:FITZPATRICK, MINDI (LMSW)
Entity Type:Individual
Prefix:
First Name:MINDI
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:70 PHILLIPS HILL RD
Mailing Address - Street 2:
Mailing Address - City:NEW CITY
Mailing Address - State:NY
Mailing Address - Zip Code:10956-4114
Mailing Address - Country:US
Mailing Address - Phone:845-639-2425
Mailing Address - Fax:845-639-2433
Practice Address - Street 1:70 PHILLIPS HILL RD
Practice Address - Street 2:
Practice Address - City:NEW CITY
Practice Address - State:NY
Practice Address - Zip Code:10956-4114
Practice Address - Country:US
Practice Address - Phone:845-639-2425
Practice Address - Fax:845-639-2433
Is Sole Proprietor?:No
Enumeration Date:2015-11-17
Last Update Date:2015-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089339104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker