Provider Demographics
NPI:1356359418
Name:FITZPATRICK, ALICIA SUSAN (LICSW)
Entity type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:SUSAN
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 HIGH ST
Mailing Address - Street 2:SUITE 240
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-2535
Mailing Address - Country:US
Mailing Address - Phone:781-775-3832
Mailing Address - Fax:
Practice Address - Street 1:745 HIGH ST
Practice Address - Street 2:SUITE 240
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-2535
Practice Address - Country:US
Practice Address - Phone:781-775-3832
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-04
Last Update Date:2008-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10311301041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAP07532OtherBCBS
MA1850521Medicaid
MATUFTSOther495520
MAP07532OtherBCBS