Provider Demographics
NPI:1922241462
Name:FITZ, IDA QUINONES (MSW)
Entity Type:Individual
Prefix:MS
First Name:IDA
Middle Name:QUINONES
Last Name:FITZ
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3900 WOODLAKE BLVD.
Mailing Address - Street 2:SUITE #207
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33463-3044
Mailing Address - Country:US
Mailing Address - Phone:561-307-1766
Mailing Address - Fax:561-967-4543
Practice Address - Street 1:3900 WOODLAKE BLVD
Practice Address - Street 2:SUITE #207
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33463-3044
Practice Address - Country:US
Practice Address - Phone:561-307-1766
Practice Address - Fax:561-967-4543
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-14
Last Update Date:2009-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW60911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical