Provider Demographics
NPI:1700473279
Name:FITZPATRICK, KEDRA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:KEDRA
Middle Name:
Last Name:FITZPATRICK
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MRS
Other - First Name:KEDRA
Other - Middle Name:FITZPATRICK
Other - Last Name:WEINRAUCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:533 NAVAHO RD
Mailing Address - Street 2:
Mailing Address - City:SHELBYVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40065-1981
Mailing Address - Country:US
Mailing Address - Phone:502-797-6006
Mailing Address - Fax:
Practice Address - Street 1:533 NAVAHO RD
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1981
Practice Address - Country:US
Practice Address - Phone:502-648-0210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical