Provider Demographics
NPI:1609414242
Name:FITZPATRICK, LAURA BETH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:BETH
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4075 PARK BLVD STE 102-152
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-2670
Mailing Address - Country:US
Mailing Address - Phone:858-215-2545
Mailing Address - Fax:
Practice Address - Street 1:3322 29TH ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92104-4533
Practice Address - Country:US
Practice Address - Phone:858-215-2545
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-12-13
Last Update Date:2020-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA31518103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical