Provider Demographics
NPI:1821110487
Name:FITZPATRICK, ROSALEEN (MFT)
Entity Type:Individual
Prefix:MS
First Name:ROSALEEN
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 S MADISON AVE UNIT 321
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91101-3322
Mailing Address - Country:US
Mailing Address - Phone:626-440-7264
Mailing Address - Fax:
Practice Address - Street 1:301 E COLORADO BLVD STE 628
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-1918
Practice Address - Country:US
Practice Address - Phone:626-440-7264
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2008-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 38857106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist