Provider Demographics
NPI:1689777013
Name:FITZPATRICK, PAULINA
Entity Type:Individual
Prefix:MS
First Name:PAULINA
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BLACK GOLD BLVD
Mailing Address - Street 2:ARH BARIATRICS, SUITE 102, ARH MEDICAL MALL
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2620
Mailing Address - Country:US
Mailing Address - Phone:606-439-6819
Mailing Address - Fax:606-439-6701
Practice Address - Street 1:210 BLACK GOLD BLVD
Practice Address - Street 2:ARH BARIATRICS, SUITE 102, ARH MEDICAL MALL
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2620
Practice Address - Country:US
Practice Address - Phone:606-439-6819
Practice Address - Fax:606-439-6701
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0781103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist