Provider Demographics
NPI:1992836050
Name:FITZPATRICK, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E CHESTNUT ST UNIT 600
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-5705
Mailing Address - Country:US
Mailing Address - Phone:502-588-4425
Mailing Address - Fax:502-588-4427
Practice Address - Street 1:401 E CHESTNUT ST UNIT 610
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-5711
Practice Address - Country:US
Practice Address - Phone:502-588-4450
Practice Address - Fax:502-588-9539
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY895101YA0400X
KY168458101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)