Provider Demographics
NPI:1952057622
Name:FITZPATRICK, KERRY (LSW)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 S BROAD ST STE 2230
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19110-1021
Mailing Address - Country:US
Mailing Address - Phone:267-704-9669
Mailing Address - Fax:267-541-2658
Practice Address - Street 1:100 S BROAD ST STE 2230
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19110-1021
Practice Address - Country:US
Practice Address - Phone:267-704-9669
Practice Address - Fax:267-541-2658
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW136397101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)