Provider Demographics
NPI:1770675746
Name:FITZPATRICK, GERALDINE VERONICA (LICENSEDPROFESSIONAL)
Entity Type:Individual
Prefix:MS
First Name:GERALDINE
Middle Name:VERONICA
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LICENSEDPROFESSIONAL
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 W WISSAHICKON AVE
Mailing Address - Street 2:
Mailing Address - City:FLOURTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19031-1802
Mailing Address - Country:US
Mailing Address - Phone:215-914-4191
Mailing Address - Fax:
Practice Address - Street 1:521 MOREDON RD
Practice Address - Street 2:
Practice Address - City:HUNTINGDON VALLEY
Practice Address - State:PA
Practice Address - Zip Code:19006-7705
Practice Address - Country:US
Practice Address - Phone:221-591-4419
Practice Address - Fax:215-947-4197
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC000991101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health