Provider Demographics
NPI:1396857371
Name:FITZPATRICK, THERESE MARIE (LPC)
Entity type:Individual
Prefix:
First Name:THERESE
Middle Name:MARIE
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10119 LAUREL AVE
Mailing Address - Street 2:
Mailing Address - City:N HUNTINGDON
Mailing Address - State:PA
Mailing Address - Zip Code:15642-2568
Mailing Address - Country:US
Mailing Address - Phone:724-454-4913
Mailing Address - Fax:
Practice Address - Street 1:225 HUMPHREY RD
Practice Address - Street 2:SUITE 4
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-4571
Practice Address - Country:US
Practice Address - Phone:724-832-9096
Practice Address - Fax:724-832-2249
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC002179101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1693265OtherHIGHMARK BLUE CROSS