Provider Demographics
NPI:1336206648
Name:FITZPATRICK, CORY MARIE (PHD)
Entity Type:Individual
Prefix:MRS
First Name:CORY
Middle Name:MARIE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:CORY
Other - Middle Name:MARIE
Other - Last Name:LAZANSKY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:2345 FAIR OAKS BLVD
Mailing Address - Street 2:MENTAL HEALTH #15
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-4708
Mailing Address - Country:US
Mailing Address - Phone:916-480-6914
Mailing Address - Fax:916-480-6920
Practice Address - Street 1:2031 HOWE AVE STE 200
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-0178
Practice Address - Country:US
Practice Address - Phone:916-541-4145
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-03
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY18294103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical