Provider Demographics
NPI:1720210966
Name:FITZHENRY, WILLIAM J (CASAC)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:J
Last Name:FITZHENRY
Suffix:
Gender:M
Credentials:CASAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 HIGHLAND AVE EXT
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10940-4437
Mailing Address - Country:US
Mailing Address - Phone:845-344-5656
Mailing Address - Fax:
Practice Address - Street 1:420 E MAIN ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-2516
Practice Address - Country:US
Practice Address - Phone:845-342-5300
Practice Address - Fax:845-342-5602
Is Sole Proprietor?:No
Enumeration Date:2009-08-21
Last Update Date:2009-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator