Provider Demographics
NPI:1639723281
Name:FITZSIMMONS, KATHERINE (MSW, LSW)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:
Last Name:FITZSIMMONS
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 REILLY RUN UNIT C
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:OH
Mailing Address - Zip Code:43123-9118
Mailing Address - Country:US
Mailing Address - Phone:614-353-9365
Mailing Address - Fax:
Practice Address - Street 1:5050 BLAZER PKWY STE 201
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3361
Practice Address - Country:US
Practice Address - Phone:614-353-9365
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-31
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHS.19039451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHS.1903945OtherOHIO COUNSELOR, SOCIAL WORKER & MFT BOARD